Bone fixation system including K-wire compression

ABSTRACT

A bone fixation system includes a bone plate, bone anchors, temporary fixation members, and forceps. The temporary fixation members are configured to be inserted through apertures in the bone plate and into underlying bone segments that are separated by a bone gap. The forceps are configured to apply a force to the temporary fixation members that causes at least one of the underlying bone segments to translate with respect to the other bone segment, thereby reducing or distracting the bone segments without interfering with final fixation by screws of bone segments.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No. 13/095,339filed Apr. 27, 2011, which claims the benefit of U.S. ProvisionApplication Ser. No. 61/372,212 filed Aug. 10, 2010 and U.S. ProvisionalApplication Ser. No. 61/328,278 filed Apr. 27, 2010, the contents of allof which are incorporated herein by reference in their entirety.

BACKGROUND

Conventional bone fixation systems include a bone plate having screwholes that receive fixation members, such as screws that are configuredto attach to underlying bone that includes, at a minimum, a pair of bonesegments separated by a bone gap. The bone gap can be a fracture createdby a traumatic event, an osteotomy, or can be the result of debridementof a joint of two discrete bones to be joined in an arthodesis. Thus,the bone plate can be affixed to the bone on opposed sides of the bonegap via the bone screws to promote union of the bone segments (e.g.,healing of the fracture or ossification of the joint). Bone fixationsystems can further include temporary Kirschner wires (K-wires) that aretemporarily inserted into apertures of the bone fixation plate and intothe underlying bone segments to determine proper length, rotation andalignment of the bone segments prior to permanent plate fixation. Oncethe bone fixation plate has been properly positioned, the permanent bonescrews can be inserted into one or more bone screw holes on opposedsides of the bone gap and affixed to the underlying bone.

In one conventional system, a K-wire is screwed or otherwise driventhrough the screw holes of the plate on opposite sides of the bone gap.The K-wire is smaller in diameter as the screw holes, and is thuspositioned so as to bear against opposing edges of the respective screwholes so as to prevent movement of the plate during imaging. The processof accurately positioning the K-wire so as to prevent movement of thebone plate has proven difficult and tedious, as any space between theK-wire and the outer edge of the screw hole can allow movement of thebone plate.

SUMMARY

In accordance with one embodiment, a method is provided for fixing abone plate to first and second bone segments that are separated by abone gap. The method includes the step of aligning the bone plate withthe first and second bone segments such that a first plurality ofapertures extending through the bone plate are aligned with the firstbone segment and a second plurality of apertures extending through thebone plate are aligned with the second bone segment. A select one of thefirst plurality of apertures is a K-wire slot and a select one of thesecond plurality of apertures is a K-wire hole. The method furtherincludes the steps of inserting a distal portion of a first K-wirethrough the K-wire slot and into the first bone segment, inserting adistal portion of a second K-wire through the K-wire hole and into thesecond bone segment, and actuating a forceps to bias at least one of theK-wires to translate relative to the other K-wire.

In accordance with another embodiment, a forceps is provided that isconfigured to apply a biasing force to a pair of temporary fixationmembers. Each temporary fixation member has a distal portion and anengagement member disposed proximal of the distal portion. Theengagement member may define a dimension greater than that of the distalportion, and the engagement member may present an outer surface. Theforceps may comprise a pair of arms that are pivotally connected at ajoint. Each arm may have a proximal end and an opposed distal end. Eacharm may further have an engagement member defining a pocket that extendsinto the distal end. The pocket may define an engagement surface havinga shape corresponding to that of the engagement member of the temporaryfixation members. Relative movement of the arms causes the distal endsto correspondingly move, such that each pocket at least partiallyreceives a respective one of the temporary fixation members and theengagement surface applies a biasing force against the engagement memberof the received temporary fixation member.

In accordance with another embodiment, a bone fixation kit is providedthat includes at least one bone fixation plate, at least a pair oftemporary fixation members, and a forceps. The plate may include aplurality of apertures, at least some of which are configured to receiverespective bone fixation members. Each temporary fixation member may aproximal portion, a distal portion, and an engagement member disposedbetween the proximal portion and the distal portion. The engagementmember may define a cross-sectional dimension greater than that of thedistal portion, wherein at least one of the temporary fixation membersis configured to extend through a respective one of the plurality ofapertures and into an underlying bone segment of a pair of underlyingbone segments that are separated by a bone gap. The forceps may includea pair of arms, each arm having a proximal end and an opposed distalend. The distal end may include an engagement member that defines acorresponding engagement surface that is configured to move along adirection so as to abut an engagement member of a respective one of thetemporary fixation members, wherein further movement of the engagementsurface along the direction causes at least one of the temporaryfixation members to translate relative to the other temporary fixationmember.

In accordance with another embodiment, a method is provided forpositioning first and second bone segments that are disposed in a firstrelative position in relation to each other and are separated by a bonegap during a surgical procedure. The method includes the step ofinserting a distal portion of a first temporary fixation member into thefirst bone segment, and inserting a distal portion of a second temporarybone fixation member into the second bone segment. The method furtherincludes the step of actuating a forceps to bias at least one of thetemporary bone fixation members relative to the other temporary bonefixation member, thereby adjusting the relative positions of the bonesegments in relation to each other from the first relative position to asecond different relative position. Prior to completion of the surgicalprocedure the first and second temporary fixation members may be removedfrom the first and second bone segments, respectively.

In accordance with another embodiment, a method is provided forpositioning a bone plate to first and second bone segments that aredisposed in a relative position in relation to each other and areseparated by a bone gap. The method may include the steps of aligningthe bone plate with the first and second bone segments, the bone plateincluding a plate body and a plurality of apertures extending throughthe plate body, wherein a first aperture of the plurality of aperturescomprises a bone anchor hole that is aligned with the first bonesegment, and a second aperture of the plurality of apertures comprises acoupler. The method further includes inserting a bone anchor through thebone anchor hole and into the first bone segment, inserting a distalportion of a post into the second aperture, the distal portion of thepost defining a coupler that engages the coupler of the second apertureto thereby fixedly couple the post to the bone plate, and inserting adistal portion of a K-wire into the second bone segment. A forceps maythen be actuated to bias at least one of the K-wire and the post totranslate relative to the other, thereby adjusting the relativepositions of the bone segments in relation to each other.

In accordance with another embodiment, a bone fixation kit is provided.The kit may include at least a pair of temporary bone fixation members,and a forceps. Each temporary bone fixation member may have a proximalportion, a distal portion, and an engagement member disposed between theproximal portion and the distal portion, the engagement member defininga cross-sectional dimension greater than that of the distal portion,wherein the temporary bone fixation members are configured to extendthrough respective ones of the plurality of apertures and intorespective underlying bone segments that are separated by a bone gap.The forceps may include a pair of arms, each arm having a proximal endand an opposed distal end, the distal end including an engagement memberthat defines a corresponding engagement surface that is configured tomove along a direction so as to abut a respective one of the temporarybone fixation members. Further movement of the engagement surface alongthe direction causes at least one of the temporary bone fixation membersto translate relative to the other temporary bone fixation member.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofan example embodiment of the application, will be better understood whenread in conjunction with the appended drawings, in which there is shownin the drawings an example embodiment for the purposes of illustration.It should be understood, however, that the application is not limited tothe precise arrangements and instrumentalities shown. In the drawings:

FIG. 1A is a perspective view of a bone fixation system constructed inaccordance with one embodiment operatively coupled to a pair ofschematically illustrated bone segments separated by a bone gap, thebone fixation system including a bone fixation plate, a pair of K-wires,and a forceps;

FIG. 1B is a perspective view similar to FIG. 1A, but showing the bonegap reduced by the bone fixation system;

FIG. 2A is a top plan view of the bone fixation plate illustrated inFIG. 1A;

FIG. 2B is a top plan view of a variable angle locking hole of the bonefixation plate illustrated in FIG. 2A;

FIG. 2C is a perspective view showing a bone anchor installed in thevariable angle locking hole illustrated in FIG. 2B;

FIG. 2D is a top plan view of a combination hole of the bone fixationplate illustrated in FIG. 2A;

FIG. 2E is a sectional side elevation view of the bone fixation plateillustrated in FIG. 2D taken along line 2E-2E so as to illustrate ascrew hole;

FIG. 2F is a sectional side elevation view of the bone fixation platesimilar to FIG. 2E, but showing the screw hole constructed in accordancewith an alternative embodiment;

FIG. 2G is a sectional side elevation view of the bone fixation platesimilar to FIG. 2F, but showing the screw hole constructed in accordancewith an alternative embodiment;

FIG. 2H is an enlarged top plan view of the bone fixation plateillustrated in FIG. 2A, showing a dedicated K-wire slot;

FIG. 2I is a top plan view of a bone fixation plate similar to FIG. 2A,but constructed in accordance with an alternative embodiment;

FIG. 3A is a perspective view of a bone fixation plate constructed inaccordance with another embodiment;

FIG. 3B is a top plan view of the bone fixation plate illustrated inFIG. 3A;

FIG. 3C is a side elevation view of the bone fixation plate illustratedin FIG. 3A;

FIG. 3D is a top plan view of a bone fixation plate constructed similarto the bone plate illustrated in FIG. 3A, but in accordance with anotherembodiment;

FIG. 3E is a top plan view of a bone fixation plate constructed similarto the bone plate illustrated in FIG. 3A, but in accordance with anotherembodiment;

FIG. 4A is a top plan view of a bone fixation plate constructed inaccordance with another embodiment;

FIG. 4B is a side elevation view of the bone fixation plate illustratedin FIG. 4A;

FIG. 4C is a top plan view of a bone fixation plate constructed inaccordance with another embodiment;

FIG. 4D is a top plan view of a bone fixation plate constructed similarto FIG. 4C, but in accordance with another embodiment;

FIG. 4E is a top plan view of a bone fixation plate constructed inaccordance with another embodiment;

FIG. 4F is a top plan view of a bone fixation plate constructed inaccordance with another embodiment;

FIG. 4G is a top plan view of a bone fixation plate constructed inaccordance with another embodiment;

FIG. 5A is a side elevation view of a non-locking bone anchorconstructed in accordance with one embodiment;

FIG. 5B is a side elevation view of a locking bone anchor constructed inaccordance with an alternative embodiment;

FIG. 5C is a side elevation view of a head portion of the bone anchorillustrated in FIG. 5B;

FIG. 5D is a sectional side elevation view of a locking bone anchorconstructed in accordance with an alternative embodiment;

FIG. 6A is a side elevation view of the K-Wire illustrated in FIG. 1A;

FIG. 6B is a side elevation view of a K-wire constructed in accordancewith an alternative embodiment;

FIG. 7A is a perspective view of the forceps illustrated in FIG. 1A;

FIG. 7B is a perspective view of the forceps illustrated in FIG. 7Ashown in an open configuration;

FIG. 7C is a perspective view of the forceps illustrated in FIG. 7Bshown in a closed configuration;

FIG. 7D is a perspective view of a portion of the forceps illustrated inFIG. 7A, showing a ratchet mechanism;

FIG. 7E is an enlarged perspective view of a distal end of the forcepsillustrated in FIG. 7A, showing a compression engagement member;

FIG. 8A is an enlarged perspective view of a distal end of the forcepsillustrated in FIG. 7A, but constructed in accordance with analternative embodiment, including compression and distraction engagementmembers;

FIG. 8B is a perspective view of the distal end illustrated in FIG. 8A,schematically showing the compression and distraction engagement membersoperatively coupled to respective K-wires;

FIG. 8C is an enlarged perspective view of a distal end of one arm ofthe forceps illustrated in FIG. 7A, but constructed in accordance withan alternative embodiment, including a compression and distractionengagement members;

FIG. 8D is a perspective view of the distal end illustrated in FIG. 8C,schematically showing the compression and distraction engagement membersoperatively coupled to respective K-wires;

FIG. 8E is an enlarged perspective view of a distal end of one arm ofthe forceps illustrated in FIG. 7A, but constructed in accordance withan alternative embodiment, including a compression and distractionengagement members

FIG. 8F is a perspective view of the distal end illustrated in FIG. 8E,schematically showing the compression and distraction engagement membersoperatively coupled to respective K-wires;

FIG. 9 is a schematic perspective view of a bone fastener secured tobone segments using the bone fixation system illustrated in FIG. 1A;

FIG. 10 is a perspective view of a bone fixation system constructed inaccordance with an alternative embodiment operatively coupled to a pairof schematically illustrated bone segments separated by a bone gap, thebone fixation system including a bone fixation plate, a K-wire, a post,and a forceps;

FIG. 11A is a perspective view of a bone fixation plate constructed inaccordance with an alternative embodiment, and illustrated in FIG. 10;

FIG. 11B is a top plan view of the bone fixation plate illustrated inFIG. 11A;

FIG. 12A is a partial perspective of a K-wire constructed in accordancewith an alternative embodiment, and illustrated in FIG. 10;

FIG. 12B is a side elevation view of the K-wire illustrated in FIG. 12A;

FIG. 13A is a front perspective view of a post constructed in accordancewith one embodiment, and illustrated in FIG. 10;

FIG. 13B is a side elevation view of the post illustrated in FIG. 13A;

FIG. 14A is a front perspective view of a forceps constructed inaccordance with an alternative embodiment, the forceps havingcompression engagement members;

FIG. 14B is a front perspective view of the forceps illustrated in FIG.14A, but constructed in accordance with an alternative embodiment,including a distraction engagement members;

FIG. 15A is a front perspective view of the bone fixation systemillustrated in FIG. 10 reducing the bone gap defined between the firstand second bone segments, the bone fixation plate affixed to the firstbone segment with a bone anchor, the post fixedly coupled to the bonefixation plate adjacent the first bone segment, and the K-wire extendingthrough the bone plate and into the second bone segment;

FIG. 15B is a front perspective view of the bone fixation systemillustrated in FIG. 15A distracting the bone gap defined between thefirst and second bone segments with the forceps illustrated in FIG. 14B;

FIG. 16A is a front perspective view of the bone fixation systemillustrated in FIG. 10 compressing the bone gap defined between thefirst and second bone segments, the bone fixation plate affixed to thefirst bone segment with a bone anchor, the K-wire extending through thebone plate and into the second bone segment, and the post fixedlycoupled to the bone plate adjacent the second bone segment such thatdistraction of the forceps causes the bone gap to compress;

FIG. 16B is a front perspective view of the bone fixation systemillustrated in FIG. 16A distracting the bone gap defined between thefirst and second bone segments with the forceps illustrated in FIG. 14A;

FIG. 17A is a front perspective view of the bone fixation systemillustrated in FIG. 10 compressing the bone gap defined between thefirst and second bone segments, the bone fixation plate affixed to thefirst bone segment with a bone anchor, the K-wire extending directlyinto the second bone segment, and the post fixedly coupled to the boneplate adjacent the second bone segment such that compression of theforceps causes the bone gap to compress; and

FIG. 17B is a front perspective view of the bone fixation systemillustrated in FIG. 17A distracting the bone gap defined between thefirst and second bone segments with the forceps illustrated in FIG. 14B.

DETAILED DESCRIPTION

Referring initially to FIG. 1A, a bone fixation system 20 includes abone fixation plate 22, at least one guide wire or temporary fixationmember illustrated as a K-wire 24, such as a pair of opposing K-wires 24a and 24 b, and a forceps 26 configured to engage the K-wires 24 a and24 b. The bone fixation plate 22 can be operatively coupled to anunderlying bone 27 having bone segments 27 a and 27 b separated by abone gap 28. The bone gap can be a fracture created by a traumaticevent, an osteotomy, or can be the result of debridement of a joint oftwo discrete bones to be joined in an arthodesis. The bone fixationplate 22 is placed against or in proximity with the underlying bone 27,the K-wires 24 a and 24 b are inserted through the plate 22 and into therespective bone segments 27 a and 27 b, and the forceps 26 can apply aforce onto the K-wires so as to translate at least one of or both of thebone segments 27 a and 27 b, thereby adjusting the relative positions ofthe bone segments 27 a and 27 b in relation to each other. For instance,the forceps 26 can apply a compressive force that brings at least one orboth of the bone segments 27 a and 27 b toward the other, therebyreducing the bone gap 28 to promote union of the bone segments 27 a and27 b, as illustrated in FIG. 1B. In accordance with certain embodiments,the forceps 26 can apply a distractive force onto the K-wires so as tourge one or both of the bone segments 27 a and 27 b away from the other,thereby distracting the bone gap 28, for instance from the positionillustrated in FIG. 1B to the position illustrated in FIG. 1A. The bonefixation plate 22 can be geometrically configured for fixation to bone27, which can be the forefoot, midfoot, hindfoot, distal tibia, or anybone in the human body as desired, either in vivo or ex vivo. The bonefixation plate 22 can alternatively be fixed in the manner describedabove to any suitable non-human animal body bone, in vivo or ex vivo.

The bone fixation system 20 can further include a plurality (e.g., atleast two) bone anchors 30 (see FIG. 2C) that secure the bone fixationplate 22 to the underlying bone 27 on opposed sides of the bone gap 28.The bone fixation system 20 and components of the bone fixation system20 can be made from any suitable biocompatible material, such astitanium, including titanium alloys, stainless steel, ceramics, orpolymers such as polyetheretherketone (PEEK), cobalt chromium molybdenum(CoCrMo) with a porous plasma-sprayed titanium coating, or any suitablealternative material as desired.

Referring now to FIG. 2A, the bone fixation plate 22 can be made indifferent shapes and sizes for use in a wide variety of clinicalapplications. The bone fixation plate 22 is elongate along alongitudinal direction L, defines a width along a lateral direction Athat is perpendicular or substantially perpendicular to the longitudinaldirection L, and a thickness along a transverse direction T that isperpendicular or substantially perpendicular to both the longitudinaldirection L and the lateral direction A. In this regard, it should beappreciated that the various directions can extend along directions thatare 90° angularly offset from each other, or anywhere within the rangeof approximately 45° and approximately 90° angularly offset from eachother.

The bone fixation plate 22 includes a plate body 32 that extendssubstantially along a central longitudinal axis 31, and defines aproximal end 34 and a distal end 36 opposite the proximal end 34 alongthe longitudinal axis 31. The plate body 32 further includes abone-facing inner surface 38 and an opposed outer surface 40 spaced fromthe inner surface 38 along the transverse direction T. The plate body 32further defines opposed side surfaces 42 and 44 that are spaced fromeach other along the lateral direction A. The plate body 32 includes ahead portion 46 at the distal end 36 that can be configured anddimensioned to conform to the contour of the near cortex of theunderlying bone 27, and a shaft portion 48 connected to the head portion46 and disposed longitudinally proximal from the head portion 46. Theshaft portion 48 can be configured and dimensioned to conform to thecontour of the near cortex of the underlying bone 27. In accordance withthe illustrated embodiment, the head portion 46 resembles the shape of acloverleaf, though it should be appreciated that the head portion 46 canassume any geometric shape as desired. The cloverleaf-shaped plate canbe used in a number of bony applications, especially where a short bonesegment is present. The cluster of the “cloverleaf” design allows thesurgeon to place three screws for three points of fixation in a smallsurface area which can provide greater stability than two points offixation in the same surface area.

The bone facing surface 38 of the head portion 46 can be generallycoplanar with or offset from the bone facing surface 38 of the shaftportion 48. For instance, the bone facing surface 38 of the head portion46 and the shaft portion 48 can be curved so as to conform to thecontours of the underlying bone 27. The plate body 32 can furtherinclude a neck portion 50 connected between the head portion 46 and theshaft portion 48. The neck portion 50 can be straight, curved, and candefine a lateral thickness that is greater than, less than, orsubstantially equal to that of the head portion and the shaft portion48. In accordance with the illustrated embodiment, the neck portion 50has a lateral thickness less than that of the head portion 46 and theshaft portion 48.

With continuing reference to FIG. 2A, the bone plate 22 includes aplurality of apertures 39 that extend transversely through the platebody 32, from the bone-facing inner surface 38 through to the outersurface 40. The apertures 39 can include at least one such as aplurality of bone anchor holes 41, at least one such as a plurality ofK-wire holes 23 which can be dedicated K-wire holes 43, and at least onesuch as a plurality of longitudinally elongate K-wire slots 25 which canbe dedicated K-wire slots 45. As will become appreciated from thedescription below, the K-wire hole 43 and the K-wire slot 45 can bededicated to receive respective K-wires, or can each also be configuredas a bone anchor hole that are configured to receive both a bone anchorand a K-wire.

As will now be described with respect to FIGS. 2A-2G, one or more of thebone anchor holes 41 up to all of the bone anchor holes 41 can beconfigured as a variable angle hole 52, a fixed axis hole 54, acombination hole 57 including a variable angle hole portion and a fixedangle hole portion, and can further be configured as a compression hole,a threaded locking hole, or a combination of both. It should beappreciated that at least one up to all of the bone anchor hole 41, theK-wire hole 43, and the K-wire slot 45 can extend through the headportion 46, the shaft portion 48, and/or the neck portion 50 as desired.In accordance with the illustrated embodiment, the bone plate 22includes a plurality of variable angle holes 52 that extend through thehead portion 46. For instance, the bone plate 22 includes a pairvariable angle holes 52 extending through the head portion 46 that arelaterally spaced from each other and aligned along the lateral directionA, and a third variable angle hole 52 that extends through the headportion 46 at a location distal of and laterally between the holes 52.

Referring now also to FIG. 2B, each variable angle hole 52 is defined byan interior surface 55 of the bone plate body 32. The interior surface55 includes a plurality of vertical or transversely extending columns56. In accordance with the illustrated embodiment, four columns 56 areequidistantly spaced circumferentially about the hole 52, though theplate body 32 can alternatively include any number of columns asdesired, spaced circumferentially equidistantly as illustrated, or atcircumferentially variable distances as desired. Each column 56 presentsinternal threads 58 that face the hole 52 such that, if the columns 56were expanded to join each other (i.e. if extended completely around theinterior surface 55), the columns 56 would form a continuous helicalthread that extend about the central transverse axis 49. Thus, it can besaid that the threads 58 of adjacent columns 56 are operatively alignedwith each other.

It should be appreciated that while the columns 56 present internalhelical threads 58 as illustrated, the columns 56 alternatively candefine threads that are provided as teeth formed thereon. The columns ofteeth, if expanded to join each other (i.e., if extended completelyaround the interior surface 55), will not form a helical thread, but aseries of concentric ridges and grooves perpendicular to the centralaxis 49 of the bone plate hole 52. Thus, it can be said that the teethcan be operatively aligned with each other. The columns 56 arecircumferentially spaced from each other so as to define correspondingaxes that are angled with respect to the transverse central axis 49,such that a screw can extend through the hole 52 at any of the angledaxes while threadedly fixed to the threads 58.

The interior surface 55 that defines the hole 52 further includes aplurality of arcuate pockets 60 that project into the plate body 32 at alocation circumferentially between the adjacent columns 56. The pockets60 each presents an arcuate surface 62 that is concave with respect to adirection radially outward from the central axis 49 of the hole 52. Asillustrated in FIG. 2C, and as described in more detail below, the boneanchor 30 can be provided as a variable locking bone anchor 61 that canthreadedly engage the threads 58 at variable angular positions.Alternatively, the bone anchor 30 can be provided as a fixed anglelocking screw that purchases with the threaded columns 56 and extendsalong the transverse axis 49. The variable angle holes 52 can beconfigured to allow the bone anchor to engage the threads 58 at anyangular orientation as desired, up to +/−15° (e.g., within a 30° range)with respect to the central axis 49, which extends along the transversedirection T. The variable angle hole 52 is further described in U.S.Patent Application Publication No. 2008/0140130, published Jun. 12,2008, the disclosure of which is hereby incorporated by reference as ifset forth in its entirety herein.

Referring now also to FIGS. 2D-E, the fixed axis hole 54 can begenerally cylindrical, such that the bone plate body 32 defines asubstantially cylindrical interior surface 64 that is substantiallycylindrical and at least partially defines the hole 54. The hole 54, andthus the interior surface 64 can extend entirely through the plate body32, from the bone facing surface 38 through to the outer surface 40along a central transverse axis 51. The interior surface 64 can beenclosed, or the plate body 32 can define a circumferential gap 65 thatextends longitudinally through a portion of the interior surface 64, soas to extend between the fixed axis hole 54 and the variable angle hole52 of the combination hole 57. The gap 65 can extend transverselyentirely through the plate body 32, from the outer surface 40 through tothe inner surface 38. The interior surface 64 of the combination hole 57illustrated in FIG. 2D can be unthreaded such that a screw head of ascrew inserted into the hole 54 of the combination hole 57 can compressthe bone plate 22 to the underlying bone 27, and/or compress the bonefragments 27 a and 27 b together. For instance, the screw can beinserted into the underlying bone 27 at one side of the hole 54 at alocation offset with respect to the central axis of the hole, such thatas the screw is compressed against the plate 22, the hole 54 aligns withthe screw, which causes the bone plate 22 to translate in a directionthat compresses the bone fragments 27 a and 27 b.

Thus, it should be appreciated that the plate 22 can define at least oneor more discrete variable angle holes 52 and fixed axis holes 54, or theplate 22 can define at least one or more combination holes 57 thatinclude a variable angle hole 52 and a fixed axis hole 54 connected bythe gap 65 that extends transversely through the plate body 32. Inaccordance with the illustrated embodiment, the variable angle hole 52of a given combination hole 57 is spaced longitudinally distal withrespect to, and longitudinally aligned with, the respective variableangle hole 52 of a given combination hole 57. The combination hole 57 isfurther described in U.S. Patent Application Publication No.2008/0140130, published Jun. 12, 2008, the disclosure of which is herebyincorporated by reference as if set forth in its entirety herein.

The interior surface 64 can extend in a transverse direction, such thatthe hole 54 has a constant diameter along its length through the platebody 32. As illustrated in FIG. 2E, the interior surface 64 can presentinternal threads 58 that are configured to engage complementary threadsof the head of a locking bone anchor, as described in more detail below.It should be appreciated that a screw having a fixed-angle head (alsoreferred to as a fixed angle screw) can be inserted into the fixed axishole 54 along the transverse axis of the hole 54. For instance, thefixed angle screw can include a conically-shaped screw head.Alternatively, a screw having a variable angle head, (also referred toas a variable angle screw) can be inserted into the fixed axis hole 54at an angle with respect to the transverse central axis 51. Forinstance, the variable angle screw can be provided as a cortical screw,or a screw whose screw head defines an outer cancellous thread.

Alternatively, as illustrated in FIG. 2F, the interior surface 64 can betapered radially inward along the transverse direction from the outersurface 40 to the inner bone facing surface 38. The interior surface 64can be unthreaded and configured to engage an unthreaded head of acompression bone anchor that provides a compressive force against theplate 22 in a direction toward the underlying bone, as will be describedin more detail below. Alternatively, the interior surface 64 can bethreaded, as described in U.S. Pat. No. 6,206,881, the disclosure ofwhich is hereby incorporated by reference as if set forth in itsentirety herein, so as to mate with complementary threads of the head ofa locking bone anchor. Alternatively still, an outer region of theinterior surface 64 can be unthreaded so as to engage a compression boneanchor head, and an inner region of the interior surface 64 can bethreaded so as to mate with complementary threads of a locking boneanchor head.

Alternatively still, as illustrated in FIG. 2G, a portion of theinterior surface 64 can be tapered radially inward along the transversedirection from the outer surface 40 toward the inner bone facing surface38. Thus, the fixed axis hole 54 can define a diameter that decreasesalong a direction from the outer surface 40 to the inner surface 38. Aportion or all of the interior surface 64 can be substantially linear(e.g., frustoconical or generally conically tapered), such that thediameter of the hole 54 decreases linearly, or part or all of theinterior surface 64 can be curved, such that the diameter of the hole 54decreases variably along the transverse direction from the outer surface40 toward the inner surface 38.

For instance, the interior surface 64 can define a first or outertransverse region 64 a that extends transversely from the outer surface40 toward the inner surface 38, and a second or inner transverse region64 b extending from the outer transverse region 64 a towards, and to,the bone facing surface 38. The outer transverse region 64 a can betapered along the transverse direction from the outer surface 40 towardthe inner surface 38, and can be unthreaded and configured to engage anunthreaded head of a non-locking or compression bone anchor thatprovides a compressive force against the plate 22 in a direction towardthe underlying bone. The inner transverse region 64 b can extend in atransverse direction, so as to define a substantially constant diameteralong its transverse length. The inner transverse region 64 b canpresent internal threads 58 that are configured to engage complementarythreads of the head of a locking bone anchor.

It should be appreciated that while the bone plate 22 is illustrated asincluding variable angle holes 52 extending through the head portion 46and combination holes 57 extending through the shaft portion 48, thebone plate 22 can alternatively include any bone anchor hole 41 of theembodiment described above that extends through the head portion 46 andthe shaft portion 48. Furthermore, multiple embodiments of the boneanchor hole 41 can extend through head portion 46, while multipleembodiments of the bone anchor hole 41 can extend through the shaftportion 48. The anchor holes 41 extending through the head portion 46can be the same or different as the anchor holes 41 that extend throughthe shaft portion 48.

Referring again to FIGS. 1A-2A, the K-wire hole 43 and the K-wire slot45 are separated by an intermediate portion 35 configured to extend overthe bone gap 28 of the underlying bone 27, such that the proximal end 34can be fastened to one bone segment 27 a or 27 b and the distal end 36can be fastened to the other bone segment 27 a or 27 b. In this regard,it can be said that the K-wire hole 43 extends through a first portion29 of the bone plate body 32, and the K-wire slot 45 extends through asecond portion 33 of the bone plate body 32 that is longitudinallyproximally spaced from the first portion 29. Alternatively oradditionally, a K-wire slot 45 can extend through the first portion 29and a K-wire hole 43 can extend through the second portion 33. TheK-wire slot 45 can be longitudinally aligned with, the K-wire hole 43,and the intermediate portion 35 is disposed between the first and secondportions 31 and 33. At least one bone anchor hole 41 can extend throughthe bone plate body 32 at a location proximate to the K-wire hole 43(for instance at the first portion 29), and at least one bone anchorhole 41 can extend through the bone plate body 32 at a locationproximate to the K-wire slot 45 (for instance at the second portion 33).

The intermediate portion 35 can include one or more up to all of aproximal end of the head portion 46 and a distal end of the shaftportion 48, a neck portion that may extend between the head portion 46,and the shaft portion 48. Alternatively, it should be appreciated thatcertain bone plates may not define a discrete shaft portion, neckportion, and/or head portion. Accordingly, the K-wire hole 43 isoperatively aligned with one bone segment 27 a or 27 b and the K-wireslot 45 is operatively aligned with the other bone segment 27 a or 27 b.In accordance with the illustrated embodiment, the K-wire hole 43extends transversely through the head portion 46, from the outer surface40 through to the inner surface 38 at a laterally location disposedproximal of the variable angle holes 52.

The dedicated K-wire hole 43 is defined by an interior surface 66 of thebone plate 22 that extends transversely through the plate body 32, fromthe outer surface 40 through to the inner surface 38. The hole 43 can becentrally located on the longitudinal axis 31 as illustrated, orlaterally offset with respect to the longitudinal axis 31. The interiorsurface 66 can be circular in cross-section as illustrated, such thatthe hole 43 is cylindrical, or the interior surface 66 and hole 43 candefine any shape as desired. The hole 43 defines a diameter orcross-sectional dimension less than that of the bone anchor holes 41 andsubstantially equal to the diameter of the K-wire 24 that is insertedthrough the hole 43 and into the underlying bone 27. Thus, the hole 43defines a lateral dimension substantially equal to that of the K-wire24, and the longitudinal dimension substantially equal to that of theK-wire 24. As a result, the K-wire 24 can be configured to abut theinterior surface 66 as the bone gap 28 is reduced and distracted. Inthis regard, it should be appreciated that the hole 43 can alternativelybe sized greater than the K-wire 24, and the K-wire can be positioned inthe hole 43 so as to abut the interior surface 66 at the location thatis closest to the K-wire slot 45 when the underlying bone gap is to bereduced, and at the location that is furthest from the K-wire slot 45when the underlying bone gap is to be distracted. In accordance with theillustrated embodiment, the hole 43 is longitudinally aligned with theslot 45, such that the underlying bone gap 28 can be reduced anddistracted in the longitudinal direction L as desired.

Referring also to FIG. 2H, the dedicated K-wire slot 45 is defined by aninterior surface 68 of the bone plate 22 that extends transverselythrough the plate body 32, from the outer surface 40 through to theinner surface 38. The slot 45 can be centrally located on thelongitudinal axis 31 as illustrated, or laterally offset with respect tothe longitudinal axis 31. The interior surface 68 includes a pair oflongitudinally opposed terminal end portions 70 and an intermediateportion 72 extending longitudinally between the end portions 70. Thus,the slot 45 is longitudinally elongate, and is longitudinally alignedwith the K-wire hole 43.

The slot 45 defines a lateral width substantially equal to the diameterof the K-wire hole 43. Both the lateral width of the slot 45 and thediameter of the K-wire hole 43 can be substantially equal to that ofrespective K-wires 24, such that one K-wire 24 can be inserted throughthe hole 43 and fixed with respect to longitudinal and lateral motionrelative to the bone plate 22, while the other K-wire is insertedthrough the slot 45 and into the underlying bone 27 and fixed withrespect to lateral motion relative to the bone plate 22 butlongitudinally translatable within the slot 45 relative to the boneplate 22. The end portions 70 of the interior surface 68, and thus ofthe slot 45, can be curved as illustrated, and can be defined by aradius R that is substantially equal to one-half the lateral width ofthe slot 45, such that the corresponding K-wire 24 is fixed with respectto lateral movement relative to the plate 22 when the K-wire 24 isdisposed at the end portion 70. The end portions 70 can be configured inany alternative size and shape as desired. The end portions 70 define aleading edge 71 and an opposing trailing edge 73. The leading edge 71 isdisposed closer to the K-wire hole 43, and limits the compression of theunderlying bone segments 27 a-b (and reduction of the bone gap 28). Thetrailing edge 73 is spaced further from the K-wire hole 43, and limitsthe distraction of the underlying bone segments 27 a-b.

With continuing reference to FIG. 2A, the K-wire hole 43 is illustratedas extending through the head portion 46, and the K-wire slot 45 isillustrated as extending through the shaft portion 48. However, itshould be appreciated that the K-wire hole 43 can alternatively extendthrough the head portion 46, the shaft portion 48, or the neck portion50. Alternatively still, the bone plate 22 can include a plurality ofK-wire holes 43, each extending through the head portion 46, the shaftportion 48, the neck portion 50, or a combination of one or more up toall of the head portion 46, the shaft portion 48, and the neck portion50. Likewise, it should be appreciated that the K-wire slot 45 canalternatively extend through the head portion 46, the shaft portion 48,or the neck portion 50. Alternatively still, the bone plate 22 caninclude a plurality of K-wire slots 45, each extending through the headportion 46, the shaft portion 48, the neck portion 50, or a combinationof one or more up to all of the head portion 46, the shaft portion 48,and the neck portion 50, alone or in combination with the one or moreK-wire holes 43.

Furthermore, as illustrated in FIG. 2A, the K-wire hole 43 is disposedproximal of the bone anchor holes 41 that extend through the headportion 46. It should be appreciated, however, that the K-wire hole 43can alternatively be disposed distally of the bone anchor holes 41 thatextend through the head portion 46, or longitudinally between one ormore bone anchor holes 41 that extend through the head portion 46. Thus,one or more bone anchor holes 41 extending through the head portion 46can be disposed proximal to or distal of the K-wire hole 43. Similarly,one or more bone anchor holes 41 extending through the shaft portion 48can be disposed proximate to or distal of the K-wire slot 45. Forinstance, as illustrated in FIG. 2I, the slot 45 is disposed between apair of bone anchor holes 41 that are configured as variable angle holes52.

It should be appreciated that the bone plate 22 has been described abovein accordance with one embodiment, and that the bone fixation system 20can include bone plates of different geometric configurations suitablefor fixation to various bones throughout the body. For instance,referring to FIGS. 3A-C, a bone plate 74 is provided as a tarsalmetatarsal joint fusion plate that is configured to join a tarsal bone(cuneiform) to either the second or third metatarsal. In accordance withthe illustrated embodiment, the bone plate 74 includes a substantiallyT-shaped plate body 76 that extends substantially along a centrallongitudinal axis 77, and defines a proximal end 78 and a distal end 80opposite the proximal end 78 along the longitudinal axis 77.

The plate body 76 further includes a bone-facing inner surface 82 and anopposed outer surface 84 spaced from the inner surface 82 along thetransverse direction T. The plate body 76 further defines opposed sidesurfaces 79 and 81 that are spaced from each other along the lateraldirection A. The plate body 76 includes a head portion 83 at the distalend 80 that can be configured and dimensioned to conform to the contourof the near cortex, and a shaft portion 85 connected to the head portion83 and disposed longitudinally proximal from the head portion 83. Theshaft portion 85 can be configured and dimensioned to conform to thecontour of the near cortex. The head portion extends laterally outwardwith respect to the shaft on both sides of the longitudinal axis 77. Theplate body 76 further includes a neck portion 86 connected between thehead portion 83 and the shaft portion 85. The neck portion 86 defines alateral width less than that of the shaft portion 85 and the headportion 83. In accordance with the illustrated embodiment, the headportion 83 and neck portion 86 are curved, and extend transverselyinward with respect to the shaft portion 85 along the a longitudinaldistal direction from the shaft portion 85.

The bone plate 74 can include a plurality of apertures 39 extendingthrough the bone plate body 76 in the manner described above. Theapertures 39 can include at least one bone anchor hole 41, at least onededicated K-wire hole 43, and at least one longitudinally elongatededicated K-wire slot 45. The bone anchor holes 41, the K-wire hole 43,and the K-wire slot 45 can be constructed as described above withrespect to the bone plate 22. In accordance with the illustratedembodiment, the plate body 76 includes a pair of longitudinally spacedcombination holes 57 extending through the shaft portion 85, and alongitudinally extending K-wire slot 45 disposed between the combinationholes 57. The combination holes 57 and the K-wire slot 45 areillustrated as extending along the longitudinal axis 77. The plate body76 includes a pair of laterally spaced variable angle holes 52 thatextend through the head portion 83 on opposed sides of the longitudinalaxis 77, and a K-wire hole 43 that extends through the head portion 83at a location coincident with the longitudinal axis 77 and proximal fromthe variable angle holes 52.

Referring to FIG. 3D, the head portion 83 can be sized to accommodateany number of apertures 39 as desired. For instance, in accordance withthe illustrated embodiment, head portion 83 can include three apertures39, which are configured as variable angle holes 52. One of the variableangle holes 52 of the head portion 83 can be located centrally on thelongitudinal axis 77, while a pair of the variable angle holes 52 of thehead portion 83 can be disposed laterally outward with respect to thecentral variable angle hole 52. Furthermore, the shaft portion 85 caninclude a plurality of apertures 39, illustrated as combination holes57, that are spaced longitudinally proximal of the K-wire slot 45.

Referring to FIG. 3E, the head portion 83 can configured so as to impartan “L” shape onto the plate body 76. In particular, one of the sidesurfaces 79 of the head portion 83 can be substantially in line with theside surface 79 of the shaft portion 85, while the other side surface 81of the head portion 83 can be project laterally outward with respect tothe side surface 81 of the shaft portion 85. In accordance with theillustrated embodiment, the head portion 83 is not sized to accommodatean aperture 39 contained between the side surface 79 and thelongitudinal axis 77. Rather, the head portion 83 defines a firstaperture 39 on the longitudinal axis 77, and a second aperture 39disposed between the longitudinal axis 77 and the side surface 81.

Referring to FIG. 4A, and as described above, certain bone plates can beconstructed without a discrete shaft portion, neck portion, and/or headportion. One example of such a bone plate 88 includes a bone plate body90 that extends substantially along a central longitudinal axis 92, anddefines a proximal end 94 and a distal end 96 opposite the proximal end94 along the longitudinal axis 92. The plate body 90 further defines abone-facing inner surface 93 and an opposed outer surface 95 spaced fromthe inner surface 93 along the transverse direction T. The plate body 90further defines opposed side surfaces 97 and 99 that are spaced fromeach other along the lateral direction A. The plate body 90 includes ashaft portion 100 that extends between the proximal and distal ends 94and 96, respectively, and a pair of longitudinally spaced wings 102 and104 that project laterally out from both side surfaces 97 and 99 of theshaft portion 100. The wing 102 is disposed distal with respect to thewing 104, and extends laterally outward a distance greater than the wing104, though it should be appreciated that the wing 104 can extendlaterally outward a greater distance than the wing 102.

The bone plate 88 includes a plurality of apertures 40 that extendthrough the plate body 90 in the manner described above. For instance aK-wire slot 45 is disposed distal with respect to a K-wire hole 43. Thebone plate 88 further includes a plurality of bone anchor holes 41 thatextend through the body 90. For instance, a variable angle hole 52extends through both lateral sides of the wings 102 and 104. A firstvariable angle hole 52 further extends through the shaft portion 100 ata location proximal of the K-wire slot 45, and a second variable anglehole 52 extends through the shaft portion 100 at a location proximal ofthe K-wire hole 43. A combination hole 57 extends through the shaftportion 100 at a location proximal of the K-wire hole 43, and proximalof the second variable angle hole 52. As illustrated in FIG. 4B, theplate body 90 defines the intermediate portion 91 disposed between thek-wire hole 43 and the K-wire slot 45.

The intermediate portion 91 can be coplanar with the remainder of theplate body 90, or can be angularly offset from a remaining portion ofthe plate body 90 with respect to a longitudinal direction of travelalong the bone-facing inner surface 93. In particular, the inner surface93 is concave at the intermediate portion 91 in accordance with theillustrated embodiment. The plate body 90 can further be curved withrespect to a lateral direction along the bone-facing inner surface 93,for instance at the wings 102 and 104 alone or in combination with theshaft portion 100.

Referring now to FIG. 4C, it should be appreciated that the K-wire hole43 can be longitudinally offset with respect to the K-wire slot 45. Inparticular, the bone plate 88 is constructed substantially as describedabove with respect to FIG. 4A, however the wings 102 and 104 definerespective first lateral extensions 102 a and 104 a that extendlaterally out from the first side surface 97, and respective secondlateral extensions 102 b and 104 b that extend laterally out from thesecond side surface 99 at a location distal with respect to the firstextensions 102 and 104 a. Furthermore, the proximal end 94 and thedistal end 96 are laterally offset from each other. Accordingly, theK-wire slot 45 extends longitudinally, and the K-wire hole 43 islaterally offset with respect to the K-wire slot 45, such that theK-wire slot 45 and the K-wire hole 43 are not longitudinally aligned.Alternatively, as illustrated in FIG. 4D, the K-wire slot 45 and theK-wire hole 43 can both be angularly offset with respect to the centrallongitudinal axis 92, and longitudinally aligned with each other.

Referring now to FIG. 4E, an alternatively constructed bone plate 106includes a bone plate body 108 having a shaft portion 110 that extendssubstantially along a central longitudinal axis 112, and defines aproximal end 114 and a distal end 116 opposite the proximal end 114along the longitudinal axis 112. The shaft portion 110 further includesan intermediate portion 111 that extends between the proximal end 114and the distal end 116. The plate body 108 further defines a bone-facinginner surface 118 and an opposed outer surface 120 spaced from the innersurface 118 along the transverse direction T. The plate body 108 furtherdefines opposed side surfaces 121 and 123 that are spaced from eachother along the lateral direction A. The plate body 108 further includesa first pair of laterally opposed flared regions 124 a that extenddistally and laterally outward from the distal end 116 of the shaftportion 110, and a second pair of laterally opposed flared regions 124 bthat extend proximally and laterally outward from the proximal end 114of the shaft portion 110. The shaft portion 110 and the flared regions124 a-b impart a substantial X-shape to the bone plate body 108.

The bone plate 106 includes a K-wire hole 43 that extends through afirst portion 113 of the plate body 108, and a K-wire slot 45 thatextends through a second portion 115 of the plate body 108 that isdisposed proximal with respect to the first portion 113, though asdescribed above it should be appreciated that the K-wire hole 43 canextend through the second portion 115 and the K-wire slot 45 can extendthrough the first portion 115. The intermediate portion 111 extendsbetween the first and second portions 113 and 115 of the plate body 108.It should further be appreciated that the first portion 113 can includeboth a K-wire hole 43 and a K-wire slot 45, and the second portion 115can likewise include both a K-wire hole 43 and a K-wire slot 45 so as toenhance the positional flexibility of the plate 106, and allow foreither underlying bone segment 27 a or 27 b to be translated relative tothe other bone segment 27 a or 27 b. The bone plate 106 further includesa bone anchor hole 41 illustrated as a variable angle hole 52 thatextends transversely through each of the flared regions 124 a-b. Thus,one or both of the K-wire hole 43 and the K-wire slot 45 can belaterally offset with respect to one or more bone anchor holes 41, up toall of the bone anchor holes 41.

Referring now to FIG. 4F, a substantially linear bone plate 130constructed in accordance with still another alternative embodimentincludes a bone plate body 132 having a shaft portion 134 that extendssubstantially along a central longitudinal axis 136, and defines aproximal end 138 and a distal end 140 opposite the proximal end 138along the longitudinal axis 136. The shaft portion 134 further includesan intermediate portion 135 that extends between the proximal end 138and the distal end 140. The plate body 132 further defines a bone-facinginner surface 142 and an opposed outer surface 144 spaced from the innersurface 142 along the transverse direction T. The plate body 132 furtherdefines opposed side surfaces 145 and 147 that are spaced from eachother along the lateral direction A.

The bone plate 130 further includes a K-wire hole 43 and the K-wire slot45 that extend through respective first and second portions 131 and 133of the plate body 132. The first portion 131 can be disposed proximal ofor distal of the second portion 133, such that the intermediate portion135 is disposed between the first and second portions. In accordancewith the illustrated embodiment, the bone plate 130 includes a pluralityof bone anchor holes 41 illustrated as variable angle holes 52 disposedlongitudinally outward with respect to the K-wire hole 43 and the K-wireslot 45, such that the intermediate portion 135 is devoid of apertures40. As illustrated in FIG. 4G, the proximal and distal ends 138 and 140can flare laterally outward with respect to the intermediate portion 135as desired.

Referring now to FIGS. 5A-D, it should be appreciated that the boneanchors 30 can be provided as a non-locking bone screw, a locking bonescrew, a nail, pin, or any alternatively constructed fastener configuredto secure the bone plate 22 to the underlying bone 27. Furthermore, oneor more up to all of the bone anchors 30 can be provided as differentlyconstructed bone anchors. For instance, one or more up to all of thebone anchors 30 can be provided as non-locking bone screws configured tobe inserted through a bone plate (for instance in the head portion orthe shaft portion) while one or more up to all of the bone anchors 30can be provided as locking bone screws configured to be inserted througha bone plate (for instance in the head portion or the shaft portion).

Referring to FIG. 5A in particular, a bone anchor 30 is illustrated as anon-locking bone screw 150, also known as a cortex screw. Thenon-locking screw 150 includes a shaft 152 that extends distally from ascrew head 153. The shaft 152 can be at least partially threaded ortoothed, and thus configured to be secured in the underlying bone 27. Asillustrated the shaft 152 defines helical threads 154 on the outersurface thereof. The length of shaft 152 and the configuration of thethreads 154 (e.g., pitch, profile, etc.) can vary depending on theapplication. The shaft 152 defines a tip end 156 that can beself-tapping and/or self-drilling to facilitate implantation of the bonescrew 150 into the underlying bone 27. The bone screw 150 can furtherinclude a cannula 158 that extends through the head 153 and the shaft152, and is configured to receive a guide wire that assists in properplacement of the bone screw 150.

The head 153 defines an unthreaded inner engagement surface 155configured to contact the bone plate 22, and an opposing outer drivesurface 157 that includes an engagement member configured to mate with acomplementary engagement member of a driving instrument that imparts arotational movement on the bone screw 150 so as to drive the shaft 152into the underlying bone 27. During operation, the bone screw 150 isaligned with a bone anchor hole 41 of the type described above, and theshaft 152 is driven through the aligned hole 41 and into the underlyingbone 27. The shaft 152 can be driven into the underlying bone 27 untilthe inner engagement surface 155 abuts the bone plate 22, therebyapplying a compression force against the bone plate 22 toward theunderlying bone 27, and fixing the bone plate 22 to the underlying bone27. The non-locking bone screw 150 can thus also be referred to as acompression bone screw. Generally the screw head 153 defines asubstantially smooth surface at the inner engagement surface 155, andhas any suitable size and geometry corresponding to a select bone anchorhole 41. The shape of head 102 may be, for example, conically tapered,straight-sided, spherical, hemispherical, and the like. In certaininstances it may be desirable for the unthreaded engagement surface 155to abut a corresponding unthreaded interior surface of the bone plate 22that at least partially defines the bone anchor hole 41.

Referring now to FIGS. 5B-C, a bone anchor 30 is illustrated as alocking bone screw 160 having a head 162 and a shaft 164 extendingdistally from the head 162 along a central axis 165. The shaft 164 canbe at least partially threaded or toothed, and thus configured to besecured in the underlying bone 27. As illustrated the shaft 164 defineshelical threads 166 on the outer surface thereof. The length of shaft164 and the configuration of the threads 166 (e.g., pitch, profile,etc.) can vary depending on the application. The shaft 164 defines a tipend 168 that can be self-tapping and/or self-drilling to facilitateimplantation of the bone screw 160 into the underlying bone 27. The bonescrew 160 can further include a cannula in the manner described above.

The head 162 defines a drive surface 170 configured to mate with acomplementary engagement member of a driving instrument as describedabove, and a threaded engagement surface 172 configured to mate withcorresponding threads of the bone plate 22. The engagement surface 172defines helical threads 174 that define thread peaks 176 and troughs 178connected to each other by flanks 180, two adjoining flanks 180 defininga thread angle. The head 162, which is conically shaped as is usual onknown locking screws, is typically oriented such that the thread peaks176 lie on a straight line, such as lines 182 or 184, and thread troughs178 lie on another straight line, such as lines 186 or 188, wherein thepairs of lines (182, 186) and (184, 188) are substantially parallel toeach other, and can be parallel or non-parallel to the central axis 165of the screw 160. For instance, the outer diameter of the threads 174can decrease along a direction from the head 162 toward the tip 168. Thelocking screw 160 can also have a constant thread pitch (the distancefrom peak to peak, or trough to trough) as measured along the centralaxis (e.g., 165).

During operation, a bone anchor 30 which can be provided as anon-locking screw 150 or a locking screw 160, can be inserted into oneor more, up to all, of the bone anchor holes 41. Locking screws 160 andnon-locking screws can be used alone or in combination with each other,in the head portion and/or the shaft portion of the bone plate 22. Itshould be appreciated that the non-locking screw 150 is configured tocompress the bone plate 22 against the underlying bond 27 as it istightened against the bone plate 22 in the bone anchor hole 41. Thelocking screw 160 is configured to threadedly mate with a threaded boneanchor hole 41, so as to lock the screw 160 to the bone plate 22, andaffixing the bone plate 22 to the underlying bone 27 without causingcompression of the bone plate 22 against the bone 27, or otherwiselimiting compression of the bone plate 22 against the bone 27.

Referring now to FIG. 5D, the bone anchor 30 is illustrated as avariable-angle locking screw 190 having a head 192 and a shaft 194extending distally from the head 192 along a central axis 195. The shaft194 can be at least partially threaded or toothed, and thus configuredto be secured in the underlying bone 27. As illustrated the shaft 194defines helical threads 196 on the outer surface thereof. The length ofshaft 194 and the configuration of the threads 196 (e.g., pitch,profile, etc.) can vary depending on the application. The shaft 194defines a tip end 198 that can be self-tapping and/or self-drilling tofacilitate implantation of the bone screw 190 into the underlying bone27. The bone screw 190 can further include a cannula in the mannerdescribed above.

The screw head 192 is illustrated as at least partially spherical, anddefines threads 200 on an outer surface thereof. The threads 200 can bedouble lead threads, and define an arc-shaped profile 202 (e.g.,non-linear or curved) along a radius of curvature. The threads 200 thusdefine trough profile lines 204 a-f that intersect a center 206 of theradius of curvature, which is a distance 208 (measured perpendicularly)from the central axis 195 of the screw 190. If, for example, the radiusis 624 is 10 mm, the distance 208 may be about 8.2 mm for a 2.4 mm screw(the 2.4 mm refers to the major diameter of shaft 194). It should beappreciated, however, that as the radius of curvature increases, thehead 192 becomes less and less spherical in shape, causing the threadprofile to become more and more aligned with a straight line asdescribed above with respect to the locking screw 160.

The thread pitch can be constant as measured along the radius ofcurvature, but can vary from narrow-to-wide-to-narrow as measured alongthe central axis 195 in a distal direction from the head 192 toward thetip 198. This thread profile allows the variable-angle locking screw toengage a variable angle hole 52 at a selectable angle within a range ofangles while maintaining the same degree of contact with the bone plateregardless of the angle chosen. That is, the angle of the screw 190 withrespect to the central axis of the bone plate hole 52 within thepermissible range of angles does not affect the engagement of the screwhead thread 200 with respect to the interior surface 55 of the platehole 52. A tight lock is thus obtained between the screw 190 and thebone plate 22 regardless of the angle (within the range of angles) atwhich the screw 190 is inserted into the variable angle hole 52, becausethe threads 200 engage the columns 56 of thread segments 58 in preciselythe same manner, ensuring a good fit.

The non-locking bone screw 150, the locking bone screw 160, and thevariable-angle locking bone screw 190 are further described in moredetail in U.S. Patent Application Publication No. 2008/0140130,published Jun. 12, 2008, the disclosure of which is hereby incorporatedby reference as if set forth in its entirety herein.

Referring now to FIG. 6A, the K-wire 24 provides a temporary fixationmember having a wire body 212 that is longitudinally elongate along acentral axis 213. The wire body 212 defines a proximal portion 214 andan opposing distal portion 216 that is spaced from the proximal portion214 along the central axis 213. The K-wire 24 includes an engagementmember 218 that is attached to the wire body 212 and separates thedistal portion 216 from the proximal portion 214. The proximal anddistal portions 214 and 216 can be cylindrical in shape or can defineany suitable alternative shape as desired. The engagement member 218defines an outer engagement surface 220 that can be spherical asillustrated, or can define any suitable alternative shape. For instance,the outer surface 220 can be round (for instance cylindrical orotherwise curved), polygonal, or the like, and thus suitable to beengaged by the forceps 26.

The proximal portion 214 of the K-wire is configured to be engaged by aninsertion tool so as to be rotatably driven. The distal portion 216 ofthe K-wire 24 is configured to be inserted through an aperture 39 of thebone plate 22, and temporarily driven into and thus fixed to theunderlying bone 27. In particular, the K-wire 24 includes helicalthreads 222 at the distal portion 216 and a tapered or pointed drivingend or tip 224 that can present one or more cutting flutes as desiredsuch that the K-wire 24 can be self-tapping. The tip 224 is thusconfigured to be driven into an underlying bone to a depth such thatrotation of the K-wire 24 causes the threads 222 to drive into the bone27. The threads 222 extend along all or a region of the distal portion216, for instance from a location proximate to the tip 224 a locationproximate to the engagement member 218. The threads 222 can extend tothe engagement member 218, or can terminate at a location spaceddistally from the engagement member 218. Accordingly, the K-wire 24 canbe driven into underlying bone to a depth that causes the abutmentmember 28 to apply compression against the bone plate 22, or to a depththat causes the abutment member 28 to be spaced from the bone plate.

The wire body 212 can be sized and shaped as desired, and in accordancewith the illustrated embodiment is dimensioned such that the diameter ofthe proximal portion 214 and the outer diameter of the threads 222 areboth approximately 1.25 mm, though it should be appreciated that thediameter of the proximal end 24 and the outer diameter threads can besized as desired, for instance at approximately 1.6 mm, any distancebetween approximately 1.25 mm and approximately 1.6 mm, or any distanceless than approximately 1.25 mm or greater than approximately 1.6 mm. Inthis regard, it should be appreciated that the outer diameter orcross-sectional dimension of the threads 222 can be substantially equalto, greater than, or less than the diameter or cross-sectional dimensionof the proximal portion 214. As illustrated in FIG. 6A, the distalportion 216 can have a first length, and as illustrated in FIG. 6B, thedistal portion 216′ of another K-wire 24 can have a second length lessthan the first length of the distal portion 216. The distal portions ofthe K-wires 24 can have any length as a desired, such as betweenapproximately 1 mm and approximately 40 mm, or any alternative lengthsuitable for extending through the bone plate and being fixed to theunderlying bone 27.

With continuing reference to FIG. 6A, the engagement member 218 caninclude an outer surface 220 that is spherical as illustrated, but canhave any shape suitable for receiving a force that biases the K-wire 24and the underlying bone in a desired direction as defined by the boneplate aperture 40 through which the distal portion 216 extends. Forinstance, the outer surface 220 can be cylindrical in shape about thecentral axis 213, or about any axis coincident with or intersecting thecentral axis 213. In this regard, the outer surface 220 can define acircular cross-section, and oval cross-section, or any alternativecurved or polygonal shape, regular or irregular, in cross-section.Accordingly, the outer surface 220 can define a curved surface in anydirection as desired, or can be polygonal, regular or irregular, angled,or can define any alternative shape as desired. The spherical outersurface 220 allows the forceps 42 to engage the engagement member 218 atvariable approach angles, as described in more detail below. Theengagement member 218 can be integrally or discretely attached (e.g.,welded) to the wire body 212.

The outer surface 220 of the engagement member 218 defines a distalbone-plate facing end 226, an opposing proximal end 228, and anintermediate engagement surface 230 disposed between the distal end 226and the proximal end 228. As described above with respect to the outersurface 220, the engagement surface 230 can define a circularcross-section, and oval cross-section, or any alternative curved orpolygonal shape, regular or irregular, in cross-section. Accordingly,the outer surface 220 can define a curved surface in any direction asdesired, or can be polygonal, regular or irregular, angled, or candefine any alternative shape as desired. The outer surface 220 candefines a diameter or cross-sectional dimension greater than that of thedistal portion 216 of the wire body 212, and in particular a lateraldimension that is greater than that of the distal portion 216, andgreater than the aperture 45 through which the distal portion 216 of theK-wire 24 is inserted. Accordingly, the engagement member 218 canprovide a stop that is configured to abut the bone plate 22 so as tolimit the insertion depth of the K-wire 24 into the underlying bone 27.

The K-wires 24 of the bone fixation system 20 can be identicallyconstructed and configured to be inserted in either the K-wire hole 43or the K-wire slot 45 as described above. Alternatively, if the hole 34and the slot 45 define different lateral dimensions, the K-wires 24 canbe provided with different diameters or lateral dimensions, one of whichis equal to the diameter or lateral dimension of the hole 34 and theother of which is equal to the lateral width of the slot 45. The K-wires24 can be referred to as temporary fixation members, temporary boneanchors or temporary bone fixation members, as they are driven into theunderlying bone 27 and subsequently removed prior to completion of thesurgical or bone fixation procedure. The bone anchors 30, on the otherhand, can be referred to as permanent bone anchors or permanent bonefixation members, as they remain implanted in the underlying bone 27after completion of the surgical procedure, even though the bone anchors30 can be removed in a second subsequent surgical procedure.

Referring now to FIGS. 7A-C, the forceps 26 includes a pair of arms 250pivotally connected together at a joint 252, which divides the arms 250between a proximal portion 254 and an opposing distal portion 256. Theproximal portion 254 of each arm 250 defines a handle 258 that canpresent an outer grip surface 260, while the distal portion 256 of eacharm 250 defines an engagement member 262 that is configured to engagethe outer surface 220 of the engagement member 218 of a respectiveK-wire 24. The proximal portion 254 of each arm 250 is generally planar,while the distal portion 256 of each arm 250 extends inward and out ofplane with respect to the proximal portion 254. In particular, thedistal end 256 is curved such that the engagement members 262 extendtoward the engagement member 218 when the handle 258 is spaced above (oroutward from) the engagement member 218.

The arms 250 are pivotally connected, such that when the handles 258 arebrought together, the engagement members 262 are likewise broughttogether, and when the handles 258 are moved apart, the engagementmembers are likewise moved apart. Referring also to FIG. 7D, the forceps26 include a ratchet 264 that causes the arms 250 to move togetherincrementally. For instance, one of the arms 250 carries a rack 266 thatcarries a plurality of teeth 268 extending out from a rack body 269. Inaccordance with the illustrated embodiment, the rack 266 extends fromthe proximal 254 of the corresponding arm 250, and is pivotallyconnected to the arm 250 at a joint 270. The arm 250 that carries therack 266 also carries a guide 272 that defines a guide channel 273 thatreceives the rack 266.

The opposing arm 250 carries a pair of opposed channel walls 274 thatdefine a channel 276 therebetween. The channel 276 receives the rack 266which is directed into the channel 276 by the guide 272, such that therack 266 is translatable within the channel 276. The channel walls 274further carry at least one tooth 278 that can be spring-biased intoengagement with the teeth 268 of the rack 266. The tooth 278 and theteeth 268 can be configured such that the tooth 278 rides over the teeth268 as the handles 258 are brought together. The spring force providesresistance as the tooth 278 rides along each tooth 268, and biases thetooth 278 into the valleys between the adjacent teeth 268 so as toprovide tactile feedback as the handles 258, and thus the engagementmembers 262 incrementally close. The teeth 268 and 278 can further beconfigured such that interference prevents the tooth 268 from ridingalong the teeth 278 when a separation force is applied to the handles258, if desired. The tooth 278 can include an engagement surface 279that can be depressed by a user against the spring force to bring thetooth 278 out of engagement with the teeth 268 so as to allow forseparation of the handles 258, and thus separation of the engagementmembers 262. Alternatively, the teeth 268 and 278 can be configured suchthat the tooth 268 incrementally rides along the teeth 278 in the mannerdescribed above both when the handles 268, and thus the engagementmembers 262 are separated, and when the handles 268, and thus theengagement members 262, are brought together.

Referring now also to FIG. 7E, each engagement member 262 defines aninner engagement surface 280 that faces the corresponding innerengagement surface 280 of the other arm 250, and an opposing outersurface 282. When the engagement members 262 each engage a complementaryengagement member 218 of a corresponding K-wire 24, the inner surfaces280 can abut the respective outer surface 220 of the engagement members218.

In accordance with the illustrated embodiment, each engagement member262 includes a pocket 284 that projects into the inner surface 280. Thepocket 284 can have any size and shape as desired, and thus presents acorresponding inner engagement surface 286 that can have any size andshape as desired, such that the engagement surface 286 is configured toapply a compressive force on a respective engagement member 218 of aK-wire 24 that biases the corresponding K-wire 24 inwardly toward theopposing K-wire 24. The pocket 284 has an open outer end 285 configuredto at least partially receive the engagement member 218 of the K-wire 24along a direction toward the inner engagement surface 286.

In accordance with the illustrated embodiment, the engagement surface286 extends along two radii of curvature that are directed substantiallyperpendicular to each other. One radius of curvature can be greater thanthe other, such that the engagement surface 286 defines a verticalcurvature substantially equal to that of the outer surface 220 of theengagement member 218 of the K-wire 24. The engagement surface 286 candefine a horizontal radius of curvature that is greater than that of thevertical radius of curvature, such that the engagement surface 286 hasan average curvature that is greater in the vertical direction than inthe horizontal direction. It should be appreciated that the verticalcurvature can be circular and sized and shaped substantially identicalto the outer surface 220 of the respective engagement member 218. Thehorizontal average curvature can be defined by a continuously curvedsurface, one or more angled surfaces, or a straight surface (thusdefining an infinite radius of curvature). The curved surface 286 allowsthe pocket 284 to reliably receive the respective engagement member 218at varying approach angles. Alternatively, the horizontal curvature canbe substantially identical to the vertical curvature, and thussubstantially identical to the spherical outer surface 220 of theengagement member 218 of the K-wire 24.

Referring also again to FIGS. 1A-B and 2H, during operation, the boneplate 22 is aligned with and placed over or on the underlying bone 27such that the intermediate portion 35 extends over the bone gap 28, atleast one bone anchor hole 41 is aligned with the bone segment 27 a, andat least one bone anchor hole 41 is aligned with the bone segment 27 b.One of the K-wires 24 is driven through the K-wire hole 43 and into oneof the underlying bone segments 27 a or 27 b, and the other K-wire 24 isdriven through the K-wire slot 45 and into the other bone segment 27 bor 27 a. The K-wire 24 is driven through a location of the K-wire slot45 at a location spaced from the leading edge 71 such that the K-wire 24is translatable in the slot 45 toward the leading edge 71. The bone gapsite can be medically imaged to ensure that the bone plate 22 isproperly aligned with the underlying bone 27. Next, the handles 258 areseparated until the engagement members 262 are likewise separated adistance greater than that of the engagement members 218 of the K-wires24, such that the engagement surfaces 286 fit over the engagementmembers 218.

Next, the forceps 26 are actuated so as to drive the distal portions 256of the arms 250 together such that the engagement surfaces 286 movealong a first direction D1 (see FIG. 7B) until they are brought intoinitial engagement with and abut or contact the respective outerengagement surfaces 220 of the engagement members 218. The firstdirection is angularly offset with respect to the central axis 213 ofthe wire body 212, and can for instance be substantially perpendicularwith respect to the central axis 213. The pocket 284 at least partiallyreceives the engagement member 218 in its open end 285, and thus doesnot encircle the engagement member 218.

Continued actuation of the forceps 26 so as to drive the engagementmembers 262 along the first direction causes the engagement surfaces 286to apply a compressive force to the outer engagement surface 220 of theK-wire 24 disposed in the slot 45, thereby biasing the K-wire inward andcausing the K-wire 24 to translate in the slot toward the leading edge71 toward the opposing K-wire 24. The opposing K-wire 24 can be fixed inposition in the K-wire hole 43, such that the movement of the K-wire 24disposed in the slot 45 toward the opposing K-wire causes thecorresponding underlying bone segment 27 a or 27 b to translate towardthe other bone segment, thereby reducing the bone gap 28 as illustratedin FIG. 1B. In this regard, it should be appreciated that the engagementmember 262 of the forceps 26 can be referred to as a reductionengagement member. Thus, it can be said that at least one of the K-wires24 is translatable relative to the other K-wire 24 which may be fixed inposition. Referring also to FIG. 9, once the bone gap 28 has achieved adesired reduction, at least one bone anchor 30 can be driven into a boneanchor hole 41 into the bone segment 27 a, and at least one bone anchor30 can be driven into a bone anchor hole 41 into the bone segment 27 b,thereby fixing the bone segments 27 a-b in their reduced configuration.The K-wires 24 can then be removed once the bone anchors 30 have fixedthe bone plate 22 to the underlying bone 27. The engagement members 218of the K-wires 24 can be brought together to a minimum retracteddistance of X1 (see FIG. 8B), which is achieved when the engagementmembers 218 are received in the pockets 284 and abut each other.

It should be appreciated in accordance with an alternative embodimentthat the K-wire hole 23 can be replaced with a dedicated K-wire slot 45,or that a K-wire slot 45 can be added on the side of the intermediateportion 35 that includes the K-wire hole 43. Thus, the bone plate 22 caninclude a pair of K-wire slots 45 disposed on opposed sides of theintermediate portion 35 of the bone plate 22. Both K-wires 24 can beinserted through respective K-wire slots 45 at a location spaced fromthe respective leading edges 71, such that both K-wires 24 aretranslatable within their respective slots 45 toward each other. Thus,it can be said that the both K-wires 24 are movable relative to eachother. In accordance with still another embodiment, one of the K-wires24 can be disposed adjacent the leading edge 71, or one of the K-wirescan be driven into the bone 27 to a depth that causes the distalbone-plate facing end 226 to compress against the bone plate 22, therebyfixing the K-wire in position. Thus, engagement between the K-wire 24and the bone plate 22 can prevent the K-wire from translating within thebone plate 22 while the other K-wire 24 is free to translate relative tothe other K-wire 24 in the manner described above.

It should be appreciated that the K-wire slot 43 and hole 45 definerespective cross-sections suitable for receiving K-wires 24, but lessthan the cross-sections of the bone anchors 30, such that the K-wirehole 43 and slot 45 are dedicated to receive only K-wires 24. However,it should be further appreciated that the K-wire hole 23 and the K-wireslot 25 can be multipurpose, and configured to also receive a boneanchor 30. For instance, either or both of the K-wire hole 23 and theK-wire slot 25 can be provided as a bone anchor hole 41 each sized toreceive a bone anchor 30 in the manner described above.

In particular, one or both of the K-wires 24 can be inserted through abone anchor hole 41 an opposed sides of the intermediate portion anddriven into the underlying bone. The K-wires 24 have a diameter orcross-sectional dimension less than that of the bone anchor holes 41 ineither or both of the lateral and longitudinal direction. Accordingly,one or both of the K-wires 24 can be initially driven into theunderlying bone 21 at a location spaced from the leading edge of thehole 41 (portion of the interior surface that is closest to the opposingK-wire hole), such that one or both of the K-wires 24 is translatablewithin the respective hole 41 toward the other K-wire 24, therebyreducing the bone gap 28 in the manner described above. It should beappreciated that one of the K-wires 24 can be initially driven into theunderlying bone 21 at a location adjacent to the leading edge of thehole 41 such that the leading edge prevents the K-wire 24 fromtranslating toward the opposing K-wire 24. Alternatively, one of theK-wires 24 can be driven into the bone 27 to a depth that causes thedistal bone-plate facing end 226 to compress against the outer surface40 of the bone plate 22, thereby fixing the K-wire 24 in position, whilethe opposing K-wire 24 can translate within the bone anchor hole 41 asdesired.

Thus, it should be appreciated that the bone plate 22 can include atleast one K-wire slot 25 which can be in the form of a bone anchor hole41, dedicated K-wire slot 45, or any alternatively constructed aperture40 extending through the bone plate 22 and having a dimension greaterthan the cross-sectional dimension of the distal portion 216 of theK-wire 24, thus allowing the K-wire 24 to translate within the slot 25.The bone plate can further include at least one K-wire hole 23 which canbe in the form of a bone anchor hole 41, dedicated K-wire hole 43,dedicated K-wire slot 45, or any alternatively constructed aperture 40,at least partially defined by a surface (which can be an interiorsurface such as the interior surface 55 illustrated in FIG. 2A or anouter bone plate surface 40) that is configured to prevent the K-wirehole 43 from translating toward the opposing K-wire 24.

It should be further appreciated that the methods described herein caninclude the steps of inserting the K-wires 24 into the underlying bonesegments 27 a-b without first placing a bone fixation plate over thebone segments, such that the forceps 26 can actuate one or both theK-wires 24 in the manner described herein to adjust the K-wires 24, andthus the underlying bone segments 27 a-b, from a first relative positionto a second different relative position so as to correspondingly adjustthe size of the bone gap 28.

Referring now to FIG. 8A, it should be appreciated that the forceps 26provides an instrument that can be configured to reduce the bone gap 28in the manner described above, and can further be configured to distractthe bone segments 27 a-b. Thus, whether the bone gap 28 is reduced, orthe bone segments 27 a-b are distracted, it should be appreciated thatat least one or both of the bone segments 27 a-b are moved from a firstposition in relation to each other to a second relative position inrelation to each other. The forceps 26 are configured to bias at leastone of the K-wires 24 toward the other K-wire so as to change the sizeof the bone gap 28. In particular, the engagement member 262 defines theinner pocket 284 in the manner described above. Each engagement member262 further defines a second outer pocket 300 that is configured toapply a force to the respective K-wire 24 that biases the K-wire 24 in adirection away from the opposing K-wire 24. The outer pockets 300 thusface away from each other, and are offset (e.g., recessed) from thepockets 284 with respect to the first direction of travel and a seconddirection of travel D2 (see FIG. 8A) opposite the first direction D1.The pockets 300 can have any size and shape as desired, and thuspresents a corresponding outer engagement surface 302 that can have anysize and shape as desired, such that the engagement surface 302 isconfigured to apply a distractive force on a respective engagementmember 218 of a K-wire 24 that biases the K-wire 24 outward away fromthe opposing K-wire 24. In accordance with the illustrated embodiment,the outer pocket 300 is shaped substantially identically with respect tothe inner pocket 284. Thus, the outer pocket 300 has an open outer end301 configured to at least partially receive the engagement member 218of the K-wire 24 along a direction toward the outer engagement surface302.

In accordance with the illustrated embodiment, the outer engagementsurface 302 extends along two radii of curvature that are directedsubstantially perpendicular to each other. One radius of curvature canbe greater than the other, such that the engagement surface 302 definesa vertical curvature that corresponds to that of the outer surface 220of the engagement member 218 of the K-wire 24. The engagement surface302 can define a horizontal radius of curvature that is greater thanthat of the vertical radius of curvature, such that the engagementsurface 302 has an average curvature that is greater in the verticaldirection than in the horizontal direction. It should be appreciatedthat the vertical curvature can be circular and sized and shapedsubstantially identical to the outer surface 220 of the respectiveengagement member 218. The horizontal average curvature can be definedby a continuously curved surface, one or more angled surfaces, or astraight surface (thus defining an infinite radius of curvature). Thecurved surface 302 allows the pocket 300 to reliably receive therespective engagement member 218 at varying of approach angles.Alternatively, the horizontal curvature can be substantially identicalto the vertical curvature, and thus substantially identical to thespherical outer surface 220 of the engagement member 218 of the K-wire24.

Referring also again to FIGS. 1A-B, 2H, and 8B, during operation, thebone plate 22 is placed over the underlying bone 27 such that theintermediate portion 35 extends over the bone gap 28, at least one boneanchor hole 41 is aligned with the bone segment 27 a, and at least onebone anchor hole 41 is aligned with the bone segment 27 b. One of theK-wires 24 is driven through the K-wire hole 43 and into one of theunderlying bone segments 27 a or 27 b, and the other K-wire 24 is driventhrough the K-wire slot 45 and into the other bone segment 27 b or 27 a.The K-wire is driven through a location of the K-wire slot 45 at alocation spaced from the trailing edge 73 such that the K-wire 24 istranslatable in the slot 45 toward the trailing edge 73. Next, thehandles 258 are brought together so that the pockets 300 are separated adistance equal to or greater than Y1, which is the minimum distanceachievable between the pockets 300 when the pockets 284 receiverespective engagement members 218. It should be appreciated that theminimum distance Y1 is reduced when the pockets 284 are devoid ofengagement members 218. The distance Y1 is less than the distancebetween the engagement members 218 of the K-wires 24 so that theengagement surfaces 302 fit between the engagement members 218. Next,the distal portions 256 of the arms 250 are brought away from each otheralong the second direction until the engagement surfaces 302 are broughtinto initial engagement with and abut or contact the respective outerengagement surfaces 220 of the engagement members 218. The seconddirection is angularly offset with respect to the central axis 213 ofthe wire body 212, and can for instance be substantially perpendicularwith respect to the central axis 213. The pocket 300 receives theengagement member 218 in its open end 301, and thus does not encirclethe engagement member 218.

Further actuation of the distal portions 256 away from each other in thesecond direction causes the engagement surfaces 302 to bias the outerengagement surface 220 of the K-wire 24 disposed in the slot 45 outward,thereby causing the K-wire 24 to translate in the slot 45 toward thetrailing edge 73 away from the opposing K-wire 24. The opposing K-wire24 can be fixed in position in the K-wire hole 43, such that themovement of the K-wire 24 disposed in the slot 45 away the opposingK-wire causes the corresponding underlying bone segment 27 a or 27 b totranslate away from the other bone segment, thereby distracting the bonegap 28 from a position, for instance illustrated in FIG. 1B to aposition illustrated in FIG. 1A. In this regard, it should beappreciated that the engagement member 262 of the forceps 26 can also bereferred to as a distraction engagement member. Once the bone gap 28 hasachieved a desired distraction, at least one bone anchor 30 can bedriven into a bone anchor hole 41 into the bone segment 27 a, and atleast one bone anchor 30 can be driven into a bone anchor hole 41 intothe bone segment 27 b, thereby fixing the bone segments 27 a-b in theirreduced configuration.

It should be appreciated in accordance with an alternative embodimentthat the K-wire hole 23 can be replaced with a dedicated K-wire slot 45,or that a K-wire slot 45 can be added on the side of the intermediateportion 35 that includes the K-wire hole 43. Thus, the bone plate 22 caninclude a pair of K-wire slots 45 disposed on opposed sides of theintermediate portion 35 of the bone plate 22. Both K-wires 24 can beinserted through respective K-wire slots 45 at a location spaced fromthe respective trailing edges 73, such that both K-wires 24 aretranslatable within their respective slots 45 away from each other.Thus, it can be said that the both K-wires 24 are movable relative toeach other. In accordance with still another embodiment, one of theK-wires 24 can be disposed adjacent the trailing edge 73, or one of theK-wires can be driven into the bone 27 to a depth that causes the distalbone-plate facing end 226 to compress against the bone plate 22, therebyfixing the K-wire in position. Thus, engagement between the K-wire 24and the bone plate 22 can prevent the K-wire from translating within thebone plate 22 while the other K-wire 24 is free to translate relative tothe other K-wire 24 in the manner described above.

It should be appreciated that the K-wire slot 43 and hole 45 definerespective cross-sections suitable for receiving K-wires 24, but lessthan the cross-sections of the bone anchors 30, such that the K-wirehole 43 and slot 45 are dedicated to receive only K-wires 24. However,it should be further appreciated that the K-wire hole 23 and the K-wireslot 25 can be multipurpose, and configured to also receive a boneanchor 30 in the manner described above.

Thus, it should be appreciated that the bone plate 22 can include atleast one K-wire slot 25 which can be in the form of a bone anchor hole41, dedicated K-wire slot 45, or any alternatively constructed aperture40 extending through the bone plate 22 and having a dimension greaterthan the cross-sectional dimension of the distal portion 216 of theK-wire 24, thus allowing the K-wire 24 to translate within the slot 25.The bone plate 22 can further include at least one K-wire hole 23 whichcan be in the form of a bone anchor hole 41, dedicated K-wire hole 43,dedicated K-wire slot 45, or any alternatively constructed aperture 40,at least partially defined by a surface (which can be an interiorsurface such as the interior surface 55 illustrated in FIG. 2A or anouter bone plate surface 40) that is configured to prevent the K-wirehole 43 from translating away from the opposing K-wire 24.

It should be appreciated that the reduction pocket 284 and thedistraction pocket 300 have been illustrated in accordance with variousembodiments, and that the forceps 26 can include the reduction pocket284 alone or in combination with the distraction pocket 300, or canalternatively include the distraction pocket 300 without the reductionpocket 284. Furthermore, it should be appreciated that the engagementmember 262 can be constructed in accordance with any desired embodimentincluding any suitable reduction engagement surface and/or a distractionengagement surface.

Referring now to FIGS. 8C-D, the outer pocket 300 can be substantiallyaligned with the inner pocket 284 with respect to the first and seconddirections of travel. Thus, the engagement members 218 of the K-wires 24can be brought together to a minimum retracted distance of X1, which isachieved when the engagement members 218 are received in the pockets 284and abut each other. The handles 258 can be brought together so that thepockets 300 are separated a distance equal to or greater than Y2, whichis the minimum distance achievable between the pockets 300 whenengagement members 218 are disposed in the inner pockets 284, it beingappreciated that the minimum distance Y2 can be reduced further whenengagement members 218 are not disposed in the pockets 284. Because thepockets 300 and substantially aligned with the pockets 284, the distanceY2 is greater than the distance Y1, which is achieved when the pockets300 and the pockets 284 are offset with respect to the first and seconddirections of travel.

Referring now to FIGS. 8E-F, the engagement member 262 is illustrated inaccordance with an alternative embodiment as a forked engagement memberthat defines a opposed inner and outer arms 350 and 352, respectively,that define a gap 354 therebetween. The gap 354 is sized to receive theengagement member 282. The inner arm 350 defines a first surface 356that faces the gap 354, and an opposed outer surface 358 that faces theinner arm 352 of the other arm of the forceps 26. The outer arm 352likewise defines a first surface 360 that faces the gap 354, and anopposed outer surface 362. The engagement member 262 includes thereduction pocket 284 formed in the first surface 360 at the distalportion of the outer arm 352, and the distraction pocket 300 formed inthe first surface 356 at the distal portion of the inner arm 350. Thus,the reduction pocket 284 and the distraction pocket 300 face each other.The pockets 300 are illustrated as at least partially aligned with thepockets 284 along the first and second directions of travel.

During operation, the engagement members 218 of the K-wires 24 isreceived in the respective gaps 354, and the engagement members 262 canbe brought together, thereby causing the engagement members 218 to bereceived in the reduction pockets 284. As the engagement members 262 arebrought together, at least one of the engagement members 218 totranslate toward the other so as to reduce the bone gap 28 in the mannerdescribed above to a minimum distance of X3, which can be greater than,less than, or equal to X1 and X2, depending on the thickness of the arms350 and the engagement member 218. The engagement members 262 can alsobe brought away from each other from a minimum separation distance ofY3, which can be greater than, equal to, or less than Y1 and Y2,depending on the dimensions of the engagement members 262 and theengagement member 218.

Referring now to FIG. 10, the bone fixation system 20 can also include abone fixation plate 422, a temporary fixation member illustrated as aK-wire 424, a second temporary fixation member illustrated as a post425, and a forceps 426 configured to engage the K-wire 424 and the post425. The bone fixation plate 422 is placed against or in proximity withthe underlying bone 27 and is affixed to the first bone segment 27 awith a bone anchor. The K-wire 424 is inserted through the plate 422 andinto the second bone segment 27 b, the post 425 is fixedly coupled tothe bone plate 422 adjacent the first bone segment, and the forceps 426can apply a force onto the K-wire 424 and the post 425 so as totranslate at least one of or both of the bone segments 27 a and 27 b,thereby adjusting the relative positions of the bone segments 27 a and27 b in relation to each other.

Referring to FIGS. 11A and 11B, an alternatively constructed bonefixation plate 422 includes a plate body 432 that extends substantiallyalong a central longitudinal axis 431, and defines a proximal end 434and a distal end 436 opposite the proximal end 434 along thelongitudinal axis 431. The plate body 432 further includes a bone-facinginner surface 438 and an opposed outer surface 440 spaced from the innersurface 438 along the transverse direction T. The plate body 432 furtherdefines opposed side surfaces 442 and 444 that are spaced from eachother along the lateral direction A. The plate body 432 includes a headportion 446 at the distal end 436 that can be configured and dimensionedto conform to the contour of the near cortex of the underlying bone 27,and a shaft portion 448 connected to the head portion 446 and disposedlongitudinally proximal from the head portion 446. The shaft portion 448can be configured and dimensioned to conform to the contour of the nearcortex of the underlying bone 27.

With continuing reference to FIGS. 11A and 11B, the bone plate 422includes a plurality of apertures 439 that extend transversely throughthe plate body 432, from the bone-facing inner surface 438 through tothe outer surface 440. As shown, the apertures 439 include a pluralityof bone anchor holes 441, and a post receiving hole 443. In particularthe head portion 446 includes a plurality of variable angle holes 452,and the shaft portion 448 includes a plurality of combination holes 457that include a variable angle hole portion combined with a fixed anglehole portion. As shown, at least one of the combination holes 457includes an elongated fixed angle hole portion 458 that is configured toreceive the K-wire 424. It should be understood, however, that the boneplate 422 may include apertures 439 having other configuration. Forexample, at least some of the apertures 439 may be configured as acompression hole, a threaded locking hole, or a combination of both orany other configuration as desired. Furthermore, the head portion 446and the shaft portion 448 may include any of the apertures as desired.

As shown in FIG. 11B, the post receiving hole 443 extends through thehead portion 446 of the bone plate 422. The post receiving hole 443includes a coupler 460, such as threads 461 that are configured toengage threads defined by the post 425 to thereby fixedly couple thepost 425 to the bone plate 422. It should be understood, however, thatthe coupler 460 may include configurations other than threads 461, solong as the post 425 can be fixedly coupled to the bone plate 422. Forexample, the coupler 460 may define a tapered interior surface that isconfigured as a snap on mount. Furthermore, the post receiving hole 443may be located anywhere along the bone plate 422. In particular, adedicated post receiving hole 443 may be positioned at other locationson the plate 422 as desired. Alternatively, one of the bone anchor holes441 or combination holes 457 may be configured to receive the post 425to thereby define a post receiving hole 443.

As shown in FIG. 11B, the combination hole 457 that includes theelongated fixed angle hole portion 458 is configured to receive theK-wire 424 such that the K-wire 424 can translate within the elongatedfixed angle hole portion 458. In this way, the elongated fixed anglehole portion 58 may be considered a K-wire slot 564. As shown, theK-wire slot 564 includes a lateral dimension, and a longitudinaldimension that is greater than the lateral dimension to allow the K-wire424 to translate in the longitudinal direction. While the elongatedfixed angle hole portion 58 is illustrated as being combined with avariable angle hole, it should be understood that the elongated fixedangle hole portion 58 may be a stand alone fixed angle hole that is notcombined with a variable angle hole.

Now referring to FIGS. 12A and 12B, in an alternative embodiment, theK-wire 424 provides a temporary fixation member having a wire body 512that is longitudinally elongate along a central axis 513. The K-wire 424can be referred to as temporary fixation member, a temporary bone anchoror a temporary bone fixation member, as it is driven into the underlyingbone 27 and subsequently removed prior to completion of the surgical orbone fixation procedure. The wire body 512 defines a proximal portion514 and an opposing distal portion 516 that is spaced from the proximalportion 514 along the central axis 513. The K-wire 424 includes a firstengagement member 518 and a second engagement member 519 that areattached to the wire body 512 and separate the distal portion 516 fromthe proximal portion 514. The proximal and distal portions 514 and 516can be cylindrical in shape or can define any suitable alternative shapeas desired. The engagement members 518 and 519 each define an outerengagement surface 520 that can be spherical as illustrated, or candefine any suitable alternative shape. For instance, the outer surfaces520 can be round (for instance cylindrical or otherwise curved),polygonal, or the like, and thus suitable to be engaged by the forceps.

The proximal portion 514 of the K-wire is configured to be engaged by aninsertion tool so as to be rotatably driven. The distal portion 516 ofthe K-wire 424 is configured to be inserted through an aperture 439 ofthe bone plate 422, and temporarily driven into and thus fixed to theunderlying bone 27. In particular, the K-wire 424 includes helicalthreads 522 at the distal portion 516 and a tapered or pointed drivingend or tip 524 that can present one or more cutting flutes as desiredsuch that the K-wire 424 can be self-tapping. The tip 524 is thusconfigured to be driven into an underlying bone to a depth such thatrotation of the K-wire 424 causes the threads 522 to drive into the bone27. The threads 522 extend along all or a region of the distal portion516, for instance from a location proximate to the tip 524 a locationproximate to the second engagement member 519. The threads 522 canextend to the second engagement member 519, or can terminate at alocation spaced distally from the second engagement member 519.

With continuing reference to FIG. 12B, the first engagement member 518can include an outer surface 520 that is spherical as illustrated, butcan have any shape suitable for receiving a force that biases the K-wire424 and the underlying bone in a desired direction as defined by thebone plate aperture 458 through which the distal portion 516 extends.For instance, the outer surface 520 can be cylindrical in shape aboutthe central axis 513, or about any axis coincident with or intersectingthe central axis 513. In this regard, the outer surface 520 can define acircular cross-section, an oval cross-section, or any alternative curvedor polygonal shape, regular or irregular, in cross-section. Accordingly,the outer surface 520 can define a curved surface in any direction asdesired, or can be polygonal, regular or irregular, angled, or candefine any alternative shape as desired. The spherical outer surface 520allows the forceps to engage the engagement member 518 at variableapproach angles. The engagement member 518 can be integrally ordiscretely attached (e.g., welded) to the wire body 512.

Similarly the second engagement member 519 is positioned distal to thefirst engagement member 518 and can include an outer surface 520 b thatis spherical as illustrated, but can have any shape suitable for atleast one of receiving a force that biases the K-wire 424 and providinga surface to rest within the elongated fixed angle portion 458 throughwhich the K-wire 424 extends. For instance, the outer surface 520 b canbe cylindrical in shape about the central axis 513, or about any axiscoincident with or intersecting the central axis 513. In this regard,the outer surface 520 b can define a circular cross-section, an ovalcross-section, or any alternative curved or polygonal shape, regular orirregular, in cross-section. Accordingly, the outer surface 520 b candefine a curved surface in any direction as desired, or can bepolygonal, regular or irregular, angled, or can define any alternativeshape as desired. The second engagement member 519 can be integrally ordiscretely attached (e.g., welded) to the wire body 512.

When the K-wire 424 is to be inserted into the elongated fixed axis hole458 of the combination hole 457, the outer surface 520 b of the secondengagement member 519 will abut the bone plate 422 so as to limit theinsertion depth of the K-wire 424 into the underlying bone 27. Becausethe elongated fixed axis portion 458 is recessed, the second engagementmember 519 will be recessed within the elongated fixed axis portion 458thereby positioning the first engagement member 518 to be engaged by theforceps. As shown the second engagement member 519 is distal to andproximate to the first engagement member 518. In the illustratedembodiment the second engagement member 519 abuts the first engagementmember 518, though it should be understood that the first and secondengagement members 518 and 519 may be spaced along the K-wire body 512.Additionally, if the K-wire 424 is inserted through a hole such as slot45 of the bone plate 22 shown in FIG. 2A, the outer surface 520 b of thesecond engagement member 519 will not only abut the bone plate 22, butwill also be engaged by the forceps.

Referring to FIGS. 13A and 13B, the post 425 provides a temporaryfixation member having a post body 612 that is longitudinally elongatealong a central axis 613. The post 425 can be referred to as temporaryfixation member, or a temporary plate fixation member, as it is fixedlycoupled to the plate 422 and subsequently removed prior to completion ofthe surgical or bone fixation procedure. The post body 612 defines aproximal portion 614 and an opposing distal portion 616 that is spacedfrom the proximal portion 614 along the central axis 613. The post 425includes an engagement member 618 that is attached to the post body 612and separates the distal portion 616 from the proximal portion 614. Theproximal and distal portions 614 and 616 can be cylindrical in shape orcan define any suitable alternative shape as desired. The engagementmember 618 can define an outer engagement surface 620 that can bespherical as illustrated, or can define any suitable alternative shape.For instance, the outer surface 620 can be round (for instancecylindrical or otherwise curved), polygonal, or the like, and thussuitable to be engaged by the forceps.

The proximal portion 614 of the post 425 is configured to be engaged byan insertion tool so as to be rotatably driven. The distal portion 616of the post 425 is configured to be inserted into the post receivinghole 443 of the bone plate 422, and temporarily fixedly coupled to thebone plate 422. In particular, the post 425 includes a coupler such ashelical threads 622 at the distal portion 616 that are configured toengage the internal threads 461 defined by the post receiving hole 443of the bone plate 422. In the illustrated embodiment the distal portion616 tapers, though it should be understood that the distal portion 616may include other configurations as desired.

With continuing reference to FIG. 13B, the engagement member 618 caninclude an outer surface 620 that is spherical as illustrated, but canhave any shape suitable for receiving a force that biases the post 425.For instance, the outer surface 620 can be cylindrical in shape aboutthe central axis 613, or about any axis coincident with or intersectingthe central axis 613. In this regard, the outer surface 620 can define acircular cross-section, an oval cross-section, or any alternative curvedor polygonal shape, regular or irregular, in cross-section. Accordingly,the outer surface 620 can define a curved surface in any direction asdesired, or can be polygonal, regular or irregular, angled, or candefine any alternative shape as desired. The spherical outer surface 620allows the forceps to engage the engagement member 618 at variableapproach angles. The engagement member 618 can be integrally ordiscretely attached (e.g., welded) to the post body 612.

When the post 425 is to be inserted into the post receiving hole 443 ofthe bone plate 422, the outer surface 620 of the engagement member 618will abut the bone plate 422. At this point the post 425 will be fixedlycoupled to the bone plate 422, and the outer surface 620 of theengagement member 618 will be positioned to be engaged by the forcepsalong with the first engagement member 518 of the K-wire 424.

Referring to FIGS. 14A and 14B, the forceps 426 may be configured ascompression forceps 426 a as shown in FIG. 14A or as distraction forceps426 b as shown in FIG. 14B. As shown in FIGS. 14A and 14B, the forceps426 include a pair of arms 650 pivotally connected together at a joint652, which divide the arms 650 between a proximal portion 654 and anopposing distal portion 656. The proximal portion 654 is similar to theproximal portion 254 of the forceps 26 shown in FIG. 7C. The distalportions 656 of the forceps 426 extend substantially perpendicularlyfrom the bone plate when the forceps 426 are in use. Such aconfiguration allows for an above approach to the bone plate 422 withthe forceps 426. Like the forceps 26, the distal portion 656 of each arm650 of the forceps 426 defines an engagement member 662 that isconfigured to engage the outer surfaces 520 and 620 of the K-wire 424and the post 425 respectively.

Referring to FIG. 14A, the forceps 426 a are configured for compression.Therefore as the proximal portions 654 of the arms 650 are broughttogether, the engagement members 662 are likewise brought together, andwhen the proximal portions 654 are moved apart, the engagement members662 are likewise moved apart. As shown in FIG. 14A, each engagementmember 662 defines an inner engagement surface 680 that faces thecorresponding inner engagement surface 680 of the other arm 650, and anopposing outer surface 682. When the engagement members 662 each engagea complementary engagement member 518 or 618 of the K-wire 424 and thepost 425, the inner surfaces 680 can abut the respective outer surfaces520 and 620 of the engagement members 518 and 618 respectively.

In accordance with the illustrated embodiment, each engagement member662 includes a pocket 684 that projects into the inner surface 680. Thepockets 684 are configured to receive the engagement members 518 and 618of the K-wire 424 and the post 425 respectively.

Now referring to FIG. 14B, the forceps 426 b are configured fordistraction. Therefore as the proximal portions 654 of the arms 650 arebrought together, the engagement members 662 are conversely moved awayfrom each other, and when the proximal portions 654 are moved apart, theengagement members 662 are conversely brought together. As shown in FIG.14B, each engagement member 662 defines an outer engagement surface 780that faces away from the corresponding engagement surface 780 of theother arm 650, and an opposing inner surface 782. When the engagementmembers 662 each engage a complementary engagement member 518 or 618 ofthe K-wire 424 and the post 425, the inner surfaces 780 can abut therespective outer surfaces 520 and 620 of the engagement members 518 and618 respectively.

In accordance with the illustrated embodiment, each engagement member662 of the forceps 426 b includes a pocket 784 that projects into theouter surface 780. The pockets 784 are configured to receive theengagement members 518 and 618 of the K-wire 424 and the post 425respectively.

It should be understood that the forceps 426, the bone plate 422, theK-wire 424, and the post 425 may be alternatively configured to includeany of the features of the previously described forceps, bone plates,and K-wires. Therefore for example, the forceps 426 may include armsdefining internal and external engagement surfaces as shown in FIG. 8Bor 8C, or arms with front loading pockets as shown in FIG. 8E.Similarly, the bone plate 422 may include alternative shapes, apertures,and configurations as desired, the K-wire 424 and the post 425 mayinclude features described in conjunction with the K-wires 24 shown inFIGS. 6A and 6B.

Now referring to FIGS. 15A-17B, the bone fixation system 20 shown inFIG. 10 may be configured in a variety ways to move the bone segmentsrelative to each other. For example, the system 20 may be configured tocompress the bone segments using the forceps 426 a, distract the bonesegments using the forceps 426 a, compress the bone segments using theforceps 426 b, and/or distract the bone segments using the forceps 426 bdepending on the positions of the K-wire 424 and the post 425.

As shown in FIG. 15A, in one configuration the bone plate 422 may beaffixed to the first bone segment 27 a with a bone anchor 30, the post425 is fixedly coupled to the bone plate 422 adjacent the first bonesegment 27 a, and the K-wire 424 extends through the bone plate 422 andinto the second bone segment 27 b. In particular the post 425 is fixedlycoupled to the post receiving hole 443 and the K-wire 424 extendsthrough the elongated fixed angle hole 458. The forceps 426 a may thenbe positioned such that the engagement members 520 and 620 of the K-wire424 and the post 425 are received by the pockets 684 defined by theengagement members 662. By compressing or otherwise actuating theforceps 426 a, the engagement members 662 are biased toward each otherand at least one of the first bone segment 27 a and the second bonesegment 27 b moves toward the other to thereby reduce the bone gapdefined between the bone segments. In this configuration and with theforceps 426 a, the first and second bone segments are pulled toward eachother by the biasing forces against the K-wire 424 and the post 425.

Alternatively, the bone segments 27 a and 27 b may be moved away fromeach other or otherwise distracted if forceps 426 b are used. As shownin FIG. 15B, the forceps 426 b may be positioned such that theengagement members 520 and 620 of the K-wire 424 and the post 425 arereceived by the pockets 784 defined by the engagement members 662 of theforceps 426 b. By distracting or otherwise actuating the forceps 426 b,the engagement members 662 are biased away from each other and at leastone of the first bone segment 27 a and the second bone segment 27 bmoves away from the other to thereby distract the bone gap definedbetween the bone segments. In this configuration and with the forceps426 b, the first and second bone segments are pushed away from eachother by the biasing forces against the K-wire 424 and the post 425.

In another configuration and in reference to FIG. 16A, the bone plate422 may be affixed to the first bone segment 27 a with a bone anchor 30,the post 425 is fixedly coupled to the bone plate 422 adjacent thesecond bone segment 27 b, and the K-wire 424 extends through the boneplate 422 and into the second bone segment 27 b at a location closer tothe bone gap than the post 425. In particular the post 425 is fixedlycoupled to a variable angle hole that defines a post receiving hole 443,and the K-wire 424 extends through the elongated fixed angle hole 458.The forceps 426 b may then be positioned such that the engagementmembers 520 and 620 of the K-wire 424 and the post 425 are received bythe pockets 784 defined by the engagement members 662. By distracting orotherwise actuating the forceps 426 b, the engagement members 662 arebiased away from each other and at least one of the first bone segment27 a and the second bone segment 27 b moves toward the other to therebyreduce the bone gap defined between the bone segments. In thisconfiguration and with the forceps 424 b, the first bone segment 27 a ispulled by the biasing force against the post 425, and the second bonesegment 27 b is pushed by the biasing force against the K-wire 424.

Alternatively, the bone segments 27 a and 27 b may be moved away fromeach other or otherwise distracted if forceps 426 a are used. As shownin FIG. 16B, the forceps 426 a may be positioned such that theengagement members 520 and 620 of the K-wire 424 and the post 425 arereceived by the pockets 684 defined by the engagement members 662 of theforceps 426 a. By compressing or otherwise actuating the forceps 426 a,the engagement members 662 are biased toward each other and at least oneof the first bone segment 27 a and the second bone segment 27 b movesaway from the other to thereby distract the bone gap defined between thebone segments. In this configuration and with the forceps 426 a, thefirst bone segment 27 a is pushed by the biasing force against the post425, and the second bone segment 27 b is pulled by the biasing forceagainst the K-wire 424.

In another configuration and in reference to FIG. 17A, the bone plate422 may be affixed to the first bone segment 27 a with a bone anchor 30,the post 425 is fixedly coupled to the bone plate 422 adjacent thesecond bone segment 27 b, and the K-wire 424 extends directly into thesecond bone segment 27 b at a location further from the bone gap thanthe post 425. In particular the post 425 is fixedly coupled to avariable angle hole that defines a post receiving hole 443, and theK-wire 424 extends into the second bone segment 27 b without passingthrough the bone plate 422. The forceps 426 a may then be positionedsuch that the engagement members 520 and 620 of the K-wire 424 and thepost 425 are received by the pockets 684 defined by the engagementmembers 662. By compressing or otherwise actuating the forceps 426 a,the engagement members 662 are biased toward each other and at least oneof the first bone segment 27 a and the second bone segment 27 b movestoward the other to thereby reduce the bone gap defined between the bonesegments. In this configuration and with the forceps 424 a, the firstbone segment 27 a is pulled by the biasing force against the post 425,and the second bone segment 27 b is pushed by the biasing force againstthe K-wire 424.

Alternatively, the bone segments 27 a and 27 b may be moved away fromeach other or otherwise distracted if forceps 426 b are used. As shownin FIG. 17B, the forceps 426 b may be positioned such that theengagement members 520 and 620 of the K-wire 424 and the post 425 arereceived by the pockets 784 defined by the engagement members 662 of theforceps 426 b. By distracting or otherwise actuating the forceps 426 b,the engagement members 662 are biased away from each other and at leastone of the first bone segment 27 a and the second bone segment 27 bmoves away from the other to thereby distract the bone gap definedbetween the bone segments. In this configuration and with the forceps426 b, the first bone segment 27 a is pushed by the biasing forceagainst the post 425, and the second bone segment 27 b is pulled by thebiasing force against the K-wire 424.

It should be appreciated that a bone fixation kit can be provided thatincludes at one or more, up to all, of the components of the bonefixation system 20, including but not limited to one or more bonefixation plates that can be sized and shaped the same or differently, aplurality of guide wires that can be sized and shaped the same ordifferently, a plurality of bone anchors configured the same ordifferently, and one or more forceps configured the same or differently.It should be appreciated that the components of the bone kit can beprovided as described above with respect to the various embodiments andalternative embodiments. Furthermore, the components of the kit can besold contemporaneously in a common packaging, or at different times indifferent packaging.

It should be appreciated that the methods described herein can includethe steps of inserting the K-wires into the underlying bone segments 27a-b without first placing a bone fixation plate over the bone segments,such that the forceps can actuate the K-wires in the manner describedherein to adjust the underlying bone segments 27 a-b from a firstrelative position to a second different relative position. In thisregard, the bone fixation kit described above can include one or morebone fixation plates as desired, or can be devoid of bone fixationplates.

The embodiments described in connection with the illustrated embodimentshave been presented by way of illustration, and the present invention istherefore not intended to be limited to the disclosed embodiments.Furthermore, the structure and features of each the embodimentsdescribed above can be applied to the other embodiments describedherein, unless otherwise indicated. Accordingly, those skilled in theart will realize that the invention is intended to encompass allmodifications and alternative arrangements included within the spiritand scope of the invention, for instance as set forth by the appendedclaims.

The invention claimed is:
 1. A method of positioning first and secondbone segments that are disposed in a relative position in relation toeach other and are separated by a bone gap, the method comprising stepsof: aligning a bone plate with the first and second bone segments, thebone plate including a plate body and a plurality of apertures extendingthrough the plate body, wherein a first aperture of the plurality ofapertures comprises a bone anchor hole that is aligned with the firstbone segment, and a second aperture of the plurality of aperturescomprises a first coupler; inserting a bone anchor through the boneanchor hole and into the first bone segment; inserting a distal portionof a post into the second aperture without extending the post into anybone segment, the distal portion of the post defining a second couplerthat engages the first coupler of the second aperture to thereby fixedlycouple the post to the bone plate; inserting a distal portion of aK-wire into the second bone segment; causing i) a first engagementmember of a first arm of a forceps to be brought into engagement withthe K-wire and ii) a second engagement member of a second arm of theforceps to be brought into engagement with the post by actuating atleast one of the first arm and the second relative to the other so as tocause at least one of the first engagement member to translate towardthe K-wire and the second engagement member to translate toward thepost; and actuating the forceps to bias at least one of the K-wire andthe post to translate relative to the other, thereby adjusting therelative positions of the bone segments in relation to each other. 2.The method as recited in claim 1, wherein a third aperture of theplurality of apertures comprises a slot that is aligned with the secondbone segment, and inserting the distal portion of the K-wire comprisesinserting the distal portion through the slot and into the second bonesegment.
 3. The method as recited in claim 2, wherein the secondaperture is aligned with the first bone segment, and the actuating stepcomprises compressing the forceps so as to cause the bone gap to reduce.4. The method as recited in claim 2, wherein the second aperture isaligned with the second bone segment, and the actuating step comprisesdistracting the forceps so as to cause the bone gap to reduce.
 5. Themethod as recited in claim 1, wherein the step of inserting the distalportion of the K-wire comprises extending the distal portion into thesecond bone segment without extending the K-wire through the bone plate,and the actuating step comprises compressing the forceps so as to causethe bone gap to reduce.
 6. The method as recited in claim 1, wherein theK-wire includes an engagement member having a cross-sectional dimensiongreater than that of the distal portion, the post has an engagementmember, and the actuating step comprises actuating the forceps so as toapply the force to the engagement members of the K-wire and the post. 7.The method of claim 6, wherein the first engagement member defines afirst pocket, the second engagement member defines a second pocket, theactuating step includes a step of engaging the first pocket with theengagement member of the post, and engaging the second pocket with theengagement member of the K-wire.
 8. A method of positioning first andsecond bone segments that are disposed in a relative position inrelation to each other and are separated by a bone gap, the methodcomprising steps of: aligning a bone plate with the first and secondbone segments so as to align a first aperture of a plurality ofapertures of the bone plate with the first bone segment, and align asecond aperture of the plurality of apertures with one of the first andsecond bone segments; inserting a fixation member into the secondaperture of the bone plate; inserting a distal portion of a K-wire intothe second bone segment, the K-wire including an engagement memberhaving a cross-sectional dimension greater than that of the distalportion of the K-wire; causing i) a first engagement member of a firstarm of a forceps to be brought into engagement with the fixation memberand ii) a second engagement member of a second arm of the forceps to bebrought into engagement with the engagement member of the K-wire byactuating at least one of the first arm and the second arm relative tothe other so as to cause at least one of a first arm to translate towardthe fixation member and the second arm to translate toward the K-wire;and actuating the forceps to cause at least one of the fixation memberand the K-wire to translate relative to the other, thereby adjustingrelative positions of the first and second bone segments in relation toeach other.
 9. The method as recited in claim 8, wherein the firstengagement member defines a first pocket, the second engagement memberdefines a second pocket, and the causing step includes causing the firstpocket to engage an engagement member of the fixation member and causingthe second pocket to engage the engagement member of the K-wire.
 10. Themethod of claim 8, comprising inserting a bone anchor through the firstaperture and into the first bone segment before the actuating step. 11.The method as recited in claim 10, wherein inserting the fixation membercomprises inserting a coupler of the fixation member into the secondaperture so as to fixedly couple the fixation member to the plate. 12.The method as recited in claim 11, wherein the step of inserting theK-wire includes inserting the K-wire through a third aperture of theplurality of apertures and into the second bone segment, the thirdaperture defining a slot, and the step of actuating the forceps includestranslating the K-wire within the slot.
 13. The method as recited inclaim 12, wherein the aligning step comprises aligning the secondaperture with the first bone segment.
 14. The method as recited in claim12, wherein the aligning step comprises aligning the second aperturewith the second bone segment.
 15. The method as recited in claim 14,wherein the step of inserting the distal portion of the K-wire includesinserting the distal portion into the second bone segment withoutextending the K-wire through the bone plate.
 16. The method as recitedin claim 8, wherein the fixation member is a second K-wire; the step ofinserting the fixation member includes inserting a distal portion of thesecond K-wire through the second aperture into the first bone; and thestep of inserting the distal portion of the K-wire includes insertingthe distal portion of the K-wire through a third aperture of theplurality of apertures and into the second bone.
 17. The method asrecited in claim 16, wherein the third aperture defines a slot, and thestep of actuating the forceps includes translating the K-wire within theslot.
 18. The method as recited in claim 16, wherein the second K-wireincludes an engagement member having a cross-sectional dimension greaterthan that of its distal portion, and the actuating step comprisesactuating the forceps so as to apply a force to the engagement membersof the K-wire and the second K-wire.